My “Head in a Bucket” Metaphor

“How could I not have known?” This question has been asked of me, as a psychiatrist, with regard to prescribing psychiatric drugs. All those problems. How could I not have known?

This question, when asked only of psychiatrists, comes with less-than-flattering assumptions. The thought that “not knowing” is a psychiatrist affliction implies that psychiatrists either have a brain that is different from other people or that they have dark hidden motives driving their lack of awareness.

Making these assumptions about psychiatrists could block collaborative relationships, especially for any person with a history of paddling in the “mainstream” of mental health care.

Broadening this question to encompass all people, rather than just psychiatrists, can give us a better understanding of how we all got into the situation of using drugs with more risks and less benefits than we were initially taught.

Since I believe that all kinds of people working together will be required for the necessary transformation of mental health care, I’m willing to take the risk and explore one possible answer to this question:

“How can any person not have known?”

This question, originally asked of me as a psychiatrist, mirrors questions that arise in my mind when I watch people engage in behaviors with well-known risks.

Here are three examples:

Cars are the number one cause of death among Americans up till the age of 34. Forty-thousand Americans die every year through the use of cars. We still drive a lot.

Despite the known risks of eating fast food, over twenty percent of Americans eat fast food on a daily basis.

Tobacco has mandated health warning labels on every package but people still use it.

It’s as if the information about risks doesn’t make it to the decision-making center of our brains.

So this question is not only about psychiatrists. This question relates to one of the basic thought processing functions we all share.

I have a metaphor that helps me understand how this could happen to anyone, how anyone could “not know”. My “head in a bucket” metaphor for information sorting reflects the sense I get when I think about this question.

It seems to me, some days more than others, as if everyone wears a bucket over his head. This is a substantial bucket with a variety of sizes and shapes of holes drilled through it. Some sizes and shapes of information get through. Others don’t make it past the bucket to the eyes and ears and into the brain. Some chunks of information must be the wrong shape or size to get through.

This head-bucket, with all its variety of holes, is part of the cognitive operating system we’ve all inherited.

From an information gathering and sorting perspective, one job our brain has to accomplish is filtering out unnecessary information. You would be swamped in data if every sound and flicker of light were allowed into your head every moment.

This filtering process includes assignment of relative value to information. This way your filter will be able to let in important information and keep out the dross. Emotional content is one key to assigning value to categories of information. Emotions help decide how inclusive or exclusive a hole needs to be on your filter bucket. For example, it’s important for a person with a bee sting allergy to avoid bees. Bees can kill, so bees are scary. This person will notice anything bee-like in the environment.

Our drilled head-bucket filters out information for us like a champ. It blocks anything out that doesn’t match our beliefs and lets in what does. Yours does it. Mine does it. Everyone’s head-bucket does it.

Einstein noticed this. He said “It’s the theory that decides what we can observe.” I would say that it’s the holes in the invisible bucket I wear over my head that decides what I can observe.

But how do these holes get drilled in our buckets?

This answer has been known by educators, leaders, and marketing wizards for a long time. Cognitive therapists know the answer, too.

The word “belief” can be used for each of the holes that are drilled through our perception-filter head-buckets. Repetition causes belief. Emotions power the drill.

We have holes drilled by parents, teachers and advertisers. We accumulate other holes in our head-buckets through life experiences. Some, we drill using our own private repetitive thoughts. This last way to get beliefs, by drilling them on our own with repetitive thoughts, can be a curse or a blessing, depending on how we drill them.

Control over the creation of our beliefs is wielded by anyone with a way to get repeated messages to us; media owners, teachers or our own selves.

Emotions power the drill. Any emotion will work. The stronger the feeling, the more drill power. An ad that annoys you works fine. So does one that’s burns with sex and longing.The bigger the hole in your bucket, the more similar information is allowed in.

We live immersed in repetitive marketing messages. We smell marketing messages when a deep fryer or bread oven vents into the grocery store. Our world of paid advertising drills our holes and hones our beliefs for us.

Here’s something to keep in mind about this head-bucket reality-filter of ours. Each one of us believes that we are more immune than other folks to the big-bucks marketing; too smart, too self-aware or too quick on the mute button to be effected. I thought so, too.

And we may mistake our filter holes for the truth. I have.

People have products to sell. The people that own the marketing drills sell access to those drills.

We’ve voted away government money for medical research and teaching hospitals. These are now funded with pharmaceutical dollars. Selling out medical research and education to drug companies would be like letting fast food chains feed our kids in school cafeterias or allowing them to pay for our text books. This would create a public health nightmare.

When you talk to a psychiatrist, remember that the high-end drills have been there ahead of you. There may be no hole through his bucket for your shape and size of message. You’ll have to change the shape, size, direction or velocity of your information. It still might not get through.

Please. Remember that you wear a filter-bucket on your head too. Your belief holes were mostly drilled for you by others. Some of the holes in your bucket could be a little off. Mine were. I’m sure that some of mine still are.

Necessary Phoenix: Can one physician help heal the practice of medicine? After two and a half decades of work as a psychiatrist in private practice, community clinics and inpatient units, Dr. Keys shares her personal perspectives on the devolution of medical care and the needed resurrection.

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308 COMMENTS

I don’t ask this question only of psychiatrists. I also asked it of my family practice doctor for prescribing me the toxic drugs. I also asked myself how I ever allowed myself to be so misinformed and so led by the nose by the drug companies through the media. I became informed through a long and difficult process and finally disabused myself of the myth that these drugs are helpful. For a tiny fraction of people they just may be, but we all know now that they aren’t helpful for most of us. We now know that they cause great harm. People aren’t forced to eat fast food, smoke tobacco, or drive dangerously. These certainly are all choices. For the most part, people in the system are not given the choice as to whether or not they want to take the toxic drugs or not. They are forced by the biopsychiatrists and the courts to shove these things down their throats, all the time knowing how badly they make a person feel, how numb they make us emotionally, how awful they make us feel inside to the point that we kill ourselves to make that feeling stop. People are given no choice nor are most of them given all the facts about the drugs they’re being forced to take. There is no real informed consent; people are just told that they will take these drugs or else they won’t get out of the hospital or they will have someone come to their house and forcibly give them an injection. It goes on and on. So, I do have to ask the question of many people in the system, not just psychiatrists; how did you not know. I didn’t know in the beginning but I became informed. I believe that if you’re going to prescribe these things to people that you have to have researched as well as you possibly can all of the information that’s out there about them and not just what you may want to know or assume about them. I’m not attacking you but I really do want to know and your blog really didn’t answer the question for me. Why are so many professionals, and not just psychiatrists, and the American public, putting their heads in the sand and avoiding the reality of what really is? How could you not have known?

Cars. Number one cause of death in children in the US. They cannot be “safe drivers”. We’ve built a car dependent culture because of marketing that began with Henry Ford. Park your car one day in protest. Reduce your risk in a “dose dependant” way. No driver is “safe”.

I think comparing car related fatalities to psychiatric intervention is also a little off the mark. While driving could definitely be safer (and has become increasingly safer over time), risks of injury and fatality are pretty low given the the great extent of their usage. Risks are mitigated by wearing seat belts, having kids sit in back seats, airbags, and all sorts of new technologies, etc. Environmental risks are lowered by better gas mileage, cleaner fuel sources, carpooling, and public transit. Known potential harms of psychiatric interventions occur commonly enough, minor and major risks are not low, and chronic use of medication is now said to reduce lifespans by 20-25 years. These are just some of the known risks/harms, let alone the unknowns.

Additionally, like it or not (and I suppose this could be said to some extent of psychiatric practice), cars are a big part of our society/economy. For many people, getting to work, school, and access to necessities requires a car. Folks living in urban environments have more options, but folks living in rural or suburban settings do not. Basically, harm of not having a car for many is much worse than the risk driving in one, let alone the benefits driving. Psychiatry has not, to me, convincingly shown that its interventions meaningfully provide more benefits than risks of harms or risks of no action for many of its applications, and certainly not to justify its costs or in comparison to other potential interventions.

Dr. Keys, I appreciate your opening of dialogue and eagerness and genuineness in engaging, but obfuscating Psychiatry’s responsibilities for treating patients in ways that are helpful beyond risk of harm and abide by ethics of informed consent by comparing it to other industries or branches of medicine is off base to me. Of course there a lots of things not going well in our world that can be improved by meaningful research, education, thoughtfulness, and collective action. I don’t think many are against those things. We are here though to often discuss the failures, challenges,and possibiliites of mental health care, what mental health even means, and the powered relationships between doctors, patients, governments, insurance and pharmaceutical industries, and researchers. I suppose putting Psychiatry in context allows folks to make connections to other market-driven forces that put people’s lives and health at risk for someone else’s profit, but it does take some of the heat off of the criticism of the mental health industry.

Open dialog is critical. The “anti-psychiatry movement” has gotten so locked on a “target” painted on “all psychiatrists” that I’m not so sure it can move beyond this anger to solutions. If you killed all psychiatrists (“hung by the neck till dead” has been hinted at with the nazi rhetoric used on this website) you would still be left with a pharmaceutical industry marketing to the public and scads of “prescribers”; NPs, PAs, primary care docs, ob-gyn, psychologists. All this gratified self-righteous retribution and nothing would change.

I’m not wanting to “take the heat off the mental health industry”. I’d like folks to step away from the target, unlock their eyes and take a wider look. What if, for example, (this is just supposition) the pharm companies could throw psychiatrists to the wolves as scapegoats and continue to make their profits just fine? We are there now.

The media would have us believe that those interested in reform are a bunch of dangerous “scientologists”. If I believed this still I wouldn’t be writing. I did once. I risk sharing this brand with you all when I speak up here.

How has the entire responsibility for all that has gone wrong as we’ve been swept away by a culture of pills been placed at the feet of psychiatrists? Is anyone looking closely?

Stephen,
You rock. Thanks for choosing more safety for yourself, those around you and the planet.

I am in the process of re-making our life where all can be done without a car. It took a step outside the box (to another country) to see back inside the box (move the bucket around) and discover the truth of our car dependency in this country.

I was convinced there was no way to change, that an American life couldn’t be lived without a car. I think there are many places where this is true. I had gotten the clue it was wrong to drive so much but felt trapped and hopeless to do anything about it.

I’m down to 1-2 trips a week total for a family of four from two commuters and several trips a day running kids and getting groceries.

Like most American homes, the old place is in a car dependant area. We bought it 22 years ago while working under the influence of another bucket drill pattern; privacy, space, investing in an asset, the American dream of home owership, mortgage interest deductions, pressure from ever-increasing rents.

It’s possible to make decisions while under the influence of bucket drill patterns (cultural, marketing, educational) that don’t play out very well later.

But, if you have the capacity for critical thought, for independant thinking and fo0llow-up, are you suggesting that med school will not let you in? Or will kick you out, if you ask a truely challenging type of question???

What, exactly, influenced your prescribing decisions? Being taken to some high-falutin’ free-lunch, by a personnble,attractive drug rep, who told you how great the “newest, whizbang, little blue pill” would cure all the past things that did not work? That the FDA has passed it with flying colors? Didja get some free pens????

Excuse the vitriol, but it seems I am about to suffer full respiratory collapse – and I will not go to the ER, because my file has a scarlett letter on the front – and I will not be treated for my medical problem. No. I will wait, for hours, and hours, and hours, because I am crazy. Because the big fat scarlett “I” on my file, and I and, “under observation,” because ya know, I guess they will think it is all in my head, and when I decide to leave, I will be tackled, and put in the shit smearing ward. Without my physical medical conerns attended to, until I pass out.
Prediction based on my past experiences.

Margarat,
I’m sorry you’re not well today. I’m sorry you’re not able to get the medical care you need. If Stephen Boren is directly involved in your care, you may wish to contact him through other channels. If he is not, then your “vitriol” is mis-directed.

In any case your post has crossed the line from dialog for solutions to personal attacks on an individual’s character. I, myself, was called to task today for this and took a few minutes to tone my post down.

We hope to invite as many different kinds of help as possible to the table here. I, at least, don’t want to run anyone off.

Margaret, I understand your feelings. I had to recently go to a med clinic, well I felt I should, it wasn’t completely necessary. But, I had a cyst, turned out to be a sebaceous cyst on my head. Top of my head. And I couldn’t do head stands, when I did yoga. It says online to put a heating pad on it, and this will melt the hardened wax which the body then can take care of. Either I got impatient or this didn’t help, or maybe I should have started doing that way before the cyst got as big as it was before I did something about it. Anyhow, I went to the med clinic for it, and had it removed.
This first visit was completely terrifying, because I had to sit there and not know whether I would get into trouble because I’m not on “medications.” And, I actually never worried about this before, but reading all the horrifying stories of people who simply go to emergency and seem too distraught and end up being forced on something that doesn’t help them (and being made ward of the state)…. This is terrifying. http://gaia-health.com/gaia-blog/2012-05-05/psychiatry-loss-of-rights-by-diagnosis/ is just one link. I know dozens of people in the mental health system, and they simply fell into it, and there never really was anything wrong with them, they just fell into it rather than getting true help. There doesn’t seem to be any sense to it other than pretension. I mean, you can misunderstand what someone says (and when there’s gossip around about you this is way to easy to do) and they use it as material to make out that you might get violent. I found out I actually was disassociating from such gossip, and it was confusing me even further. So, I learned to completely disconnect from such people, without any feeling of loss or resentments. I could go on quite a bit with how ridiculous people respond, it’s simply like racism. That person has a genetic flaw and could become violent (same as those people of that race are dangerous or inferior). And I’m quite baffled that the references to Hitler or eugenics, in regards to this aren’t more understood. And it’s none of us wielding the power of the courts to have people force injected, to have them lose their freedoms and to have them lose their health and their life expectancy. One would think that those who do have those powers, when they see they are compared with such behavior in a way that’s not off sync, that they might consider what they do with the power they yield.
Anyhow, back on track. I was soooo, I mean SoooooooooooooooOOOOOOOO scared sitting having to wait to see the first doctor, just to find out what kind of a bump I actually had on my head. I do A Course in Miracles and had to repeatedly relax myself and repeat over and over that when I allow myself to invest in fear I am investing in it, and as an energy it is a two sided sword and goes both ways: to what I’m scared of and me. I literally was sort of frozen in time even going over what might happen to me and to not to invest in hatred, whatever happened, because I believe that our thoughts were there before time and space, remain free of it, and what happens to us depends on what we think more than anything that’s “objective,” that predictable or not; or even reasonable in many ways. The whole time I was going through this, there was part of me that just simply remained terrified, which is alright I guess, because then I’m at least aware of how much I might allow myself to invest in fear. And now, two years ago, I had fallen and sprained two wrists, and went to the med center to make sure there were no breaks. I can get rather talkative with people behind counters and such, and simply mentioned that I didn’t like doctors, that that’s not where I go for my healing necessarily. Well, this woman I said this to, when I had to walk through the hall her desk was facing to get to another room gave me such a look: squeezing her eyes at me into a pinch determined that there was something there that needed attention. And sure enough, I’m just talking with the man who did the x-rays, which all went smoothly and friendly, and when he went out into the hall for a second, she was asking him: “was he bothering you and stuff a lot?” Well, I hadn’t been, but you never know with these people. Anyone in such a situation and stressed out can get pretty annoyed. Thankfully, I wasn’t. I imagine that this lady could look in her little computer and see that I also have a scarlet I attached to my record and take out her little what’s-wrong-with-people-that-have-this-diagnosis manual and start editing what’s going on as if she’s free to exert her fantasy on reality. All because they can’t sit still and SOMETHING needs to be done about SOMETHING or they’re not able to feel safe about their fantasy anymore.

Well, I have to tell you that I’ve been blogging here on this site from an asylum, I have to give unspecified favors to an attendant in order to be allowed access to the computer (the only thing that makes me feel normal), and I’m not allowed to use my real name. Apparently this nurse from two years ago knows some people at the med center, and they finally got me. If I am found out I’ll be given a round of shock treatments and force injected for months. In the mean time the bump on my head has gotten to be as big as a marble, and they’ve told me that pills are better than yoga. It’s extremely difficult for me to blog here. I have to quietly repeat what I’ve read, and have devised signals that help me review what I’ve read and how to respond. All this because of the medications preventing me from being able to think clearly. To respond with one post in a coherent manner, something I used to be able to do within a half hour or so, now takes me days of work. I also have to spend time blocking all of the angry thoughts that could be considered personal attacks on psychiatrists, and have acquired a visible twitch from this, or is this because of the medications and I’m projecting, and need to let go?

Of course, the last paragraph is not factual…..
The cyst was removed and I can stand on my head again.
However, the truth doesn’t have to be factual.

Margaret, I understand your feelings. I had to recently go to a med clinic, well I felt I should, it wasn’t completely necessary. But, I had a cyst, turned out to be a sebaceous cyst on my head. Top of my head. And I couldn’t do head stands, when I did yoga. It says online to put a heating pad on it, and this will melt the hardened wax which the body then can take care of. Either I got impatient or this didn’t help, or maybe I should have started doing that way before the cyst got as big as it was before I did something about it. Anyhow, I went to the med clinic for it, and had it removed.
This first visit was completely terrifying, because I had to sit there and not know whether I would get into trouble because I’m not on “medications.” And, I actually never worried about this before, but reading all the horrifying stories of people who simply go to emergency and seem too distraught and end up being forced on something that doesn’t help them (and being made ward of the state)…. This is terrifying. I know dozens of people in the mental health system, and they simply fell into it, and there never really was anything wrong with them, they just fell into it rather than getting true help. There doesn’t seem to be any sense to it other than pretension. I mean, you can misunderstand what someone says (and when there’s gossip around about you this is way to easy to do) and they use it as material to make out that you might get violent. I found out I actually was disassociating from such gossip, and it was confusing me even further. So, I learned to completely disconnect from such people, without any feeling of loss or resentments. I could go on quite a bit with how ridiculous people respond, it’s simply like racism. That person has a genetic flaw and could become violent (same as those people of that race are dangerous or inferior). And I’m quite baffled that the references to Hitler or eugenics, in regards to this aren’t more understood. And it’s none of us wielding the power of the courts to have people force injected, to have them lose their freedoms and to have them lose their health and their life expectancy. One would think that those who do have those powers, when they see they are compared with such behavior in a way that’s not off sync, that they might consider what they do with the power they yield.
Anyhow, back on track. I was soooo, I mean SoooooooooooooooOOOOOOOO scared sitting having to wait to see the first doctor, just to find out what kind of a bump I actually had on my head. I do A Course in Miracles and had to repeatedly relax myself and repeat over and over that when I allow myself to invest in fear I am investing in it, and as an energy it is a two sided sword and goes both ways: to what I’m scared of and me. I literally was sort of frozen in time even going over what might happen to me and to not to invest in hatred, whatever happened, because I believe that our thoughts were there before time and space, remain free of it, and what happens to us depends on what we think more than anything that’s “objective,” that predictable or not; or even reasonable in many ways. The whole time I was going through this, there was part of me that just simply remained terrified, which is alright I guess, because then I’m at least aware of how much I might allow myself to invest in fear. And now, two years ago, I had fallen and sprained two wrists, and went to the med center to make sure there were no breaks. I can get rather talkative with people behind counters and such, and simply mentioned that I didn’t like doctors, that that’s not where I go for my healing necessarily. Well, this woman I said this to, when I had to walk through the hall her desk was facing to get to another room gave me such a look: squeezing her eyes at me into a pinch determined that there was something there that needed attention. And sure enough, I’m just talking with the man who did the x-rays, which all went smoothly and friendly, and when he went out into the hall for a second, she was asking him: “was he bothering you and stuff a lot?” Well, I hadn’t been, but you never know with these people. Anyone in such a situation and stressed out can get pretty annoyed. Thankfully, I wasn’t. I imagine that this lady could look in her little computer and see that I also have a scarlet I attached to my record and take out her little what’s-wrong-with-people-that-have-this-diagnosis manual and start editing what’s going on as if she’s free to exert her fantasy on reality. All because they can’t sit still and SOMETHING needs to be done about SOMETHING or they’re not able to feel safe about their fantasy anymore.
Well, I have to tell you that I’ve been blogging here on this site from an asylum, I have to give unspecified favors to an attendant in order to be allowed access to the computer (the only thing that makes me feel normal), and I’m not allowed to use my real name. Apparently this nurse from two years ago knows some people at the med center, and they finally got me. If I am found out I’ll be given a round of shock treatments and force injected for months. In the mean time the bump on my head has gotten to be as big as a marble, and they’ve told me that pills are better than yoga. It’s extremely difficult for me to blog here. I have to quietly repeat what I’ve read, and have devised signals that help me review what I’ve read and how to respond. All this because of the medications preventing me from being able to think clearly. To respond with one post in a coherent manner, something I used to be able to do within a half hour or so, now takes me days of work. I also have to spend time blocking all of the angry thoughts that could be considered personal attacks on psychiatrists, and have acquired a visible twitch from this, or is this because of the medications and I’m projecting, and need to let go?
Of course, the last paragraph is not factual…..
The cyst was removed and I can stand on my head again.
However, the truth doesn’t have to be factual.http://www.youtube.com/watch?v=nL6m9dRHteM

I have asked myself more than once those questions since 2008 when I became directly involved with psychiatry. Before then I thought: psychiatrists are doctors, intelligent, well-educated people, they want to help people in distress they know what they were doing etc. Reality hit me straight in the face when they nearly killed my son with their antipsychotic medication and I thought then all the doctors had gone mad. How could that have happened?
Firstly, the doctors I had to deal with, didn’t know how to listen, they didn’t have time for it.They thought they knew better than I what had happened.
Secondly they all had been taught the same thing at medical school and instead of being open-minded and using their common-sense they religeously and blindly sang from the same hymn sheet. They were so endoctrinated that they were unable to think out of the box. What I was telling them just didn’t make sense to them, so they changed my story to fit their own beliefs. I suppose when you go to medical school, you expect to be taught things that have been proven to be true.
Thirdly, at least here in Britain, once out of hospital the Hospital consultant psychiatrist doesn’t see you anymore. There is no continuity in care. He doesn’t see the ugly side of the medication he has put you on. The GP is the one who is supposed to deal with your side effects and, in reality, hasn’t much of a clue how to; nor how to get you off those antipsychotics safely either. Meanwhile the psychiatrist working on the ward gets the impression that there are no side effects to speak of to their precious medication and continues to live in blissful ignorance. I hope things have changed since 2008 although I read now and then articles which make my mind boggle Some psychiatrists are still burbling on in the same old way.

I think you’ve stated the existing problem very well. Many of the psychiatrists refuse to listen to what anyone has to say, especially the person experiencing the mental and emotional anguish. They fail to remember that every morning they put their pants on one leg at a time, or their skirt or dress on one leg at a time (I have no idea since I’ve never worn a skirt or dress but whatever), just like all the rest of us. They refuse to acknowledge that the person they’re dealing with is the only real “expert” on their own life. I suspect that a lot of this comes from the fact that many of them consider the people they’re working with to be less than they are. I was actually sitting with a person being admitted to the state hospital where I work who made the mistake of telling the psychiatrist who was going to be their doctor on the unit that he didn’t like or appreciate what the doctor had just said. That psychiatrist yelled, “I don’t care what you like or appreciate!” And because he was the psychiatrist his behavior was concered acceptable. If I’d done the same thing as the psychiatrist I would be fired on the spot because my behavior would be called disrespectful and less than acceptable. Thanks for your posts.

Stephen,
Somewhere in this particular doctor’s training and life experience he got the belief that he can do this. I wonder who drilled this hole in his belief system. Most docs behave better most of the time (I think).

I have also seen non-doctor yell, swear and throw things. Poor behavior comes from all kind of people.

Alix,
Things are quite a lot the same here. Patients in hospital may be started on a lot of drugs all at once then discharged after a short stay. Someone else, frequently a primary care doc, has to deal with the consequences of sorting out if any of it is necessary or useful or safe. Hospital stays are short. There’s no feedback loop. Every year the list of “brand new to the patient” discharge medicines is larger; bigger dosages, more complex regimens. I have no idea where this “treatment approach” comes from. (Well, yes I do. Post graduate medical education is drug funded.)

The trouble with being really smart and educated is that it gives one a false sense of security in ones ability to see the good information from the hype. It doesn’t. It also leads your patients to believe you may be above it. You’re not.

Doctors are people too and live with the same cognitive processing system as everyone else. It’s just as easy to program by marketing. Maybe more so. How often does a lovely young drug rep drop in on you at work with chocolate, flattery and drug samples to “help” the poor? I guess it depends on where you work.
No one is immune.

I think subsuming the question, “how could psychiatrists not have known,” into “how could any person not have known,” misses a big point. Psychiatrists are of course not immune to all sorts of the biases that any person experiences, but they are trained and expected to investigate and check their biases. One way people have learned to do that is to use scientific methodology critically to examine assumed causation/associations and make changes to protocols and investigate further when data suggests inconclusiveness or surprising findings. As you say, the public failed to fund teaching and research (I certainly agree), funding was replaced by industry funding, and then science was biased by industry motives, I still don’t buy that doctoral level clinician scientists (as psychiatrists are and a designation from which they exert a lot of influence) cannot critically investigate strange research methodology and conclusions that are not based what data suggest. I suppose many did not question because they were so excited by false findings, some really do not have the research skills/interest to even effectively review published literature, and some were not willing to rock establishments in fear of losing jobs, prestige, sense of helpfulness/purpose, and income. These are all understandable (though sad) possibilities really based on everyone’s unjustified trust in medicine, people who practice medicine, the scientific knowledge production and dissemination process as it stand today. I’ve written more about the failures of medicine, government, and the public in regards to the acceptance of bad science here: http://thoughtbroadcast.com/2012/02/09/measuring-the-immeasurable/#comment-3696

These elaborations on your two questions ultimately fail to answer what I think is are more pressing and useful questions now. Instead of focusing on why psychiatrists didn’t know about harms of their practices, we can look to the present. What do psychiatrists know now? If they know of harms, shoddy science, poor efficacy, and large cost of their treatments, what are they going to do about it? Are they going to change their practices in anyway? Are they going to do better science?(DSM5 field trial data points to terrible methodology and poorly written diagnostic criteria that many agree would lead to greater exposure to harmful treatments that lack reasonable benfits/risks ratios.) Should people seeking support for distress trust psychiatrists/medicine? What would make psychiatrists more trustworthy?

These questions concern me more at this point, and I have not really seen much answers to these anywhere.

I agree that “subsuming the question, ‘how could psychiatrists not have known,’ into ‘how could any person not have known,” misses a big point. Psychiatrists should know becuase these drugs are the tools of their trade and they have a professional responsibility to know what the drugs they give people actually do. The avergae person on the street doesn’t have thta same responsibility.

Emma,
I did “know” the tools of my trade as well as anyone else practicing in the field did at the time. The great “retrospectroscope” has vision that no one, not even us God-like shrinks 😉 have. All of us humans, including psychiatrists, are limited to the information available at the time. All of us are “victims” of the same cognitive operating system being manipulated by media/marketing.

Subsuming the question IS my point. We are all more alike than different. Holding psychiatrists to standards of human cognition (like knowing information not available at the time and being immune to market-driven education) only gives us self-rightcheous reasons to shoot at them.

I don’t think it wise to drive every psychiatrist away from the discussion table. Occasionally one of us may want to help.

We’re all in this together. It will take all of us to make things better. Maybe even the occasional psychiatrist.

I’m sorry, but I do think people who practice a profession have more of a responsibility than the person on the street for understanding the tools of their trade. I expect a carpenter to know how to make sturdy repairs, I expect my dentist to know how to fill a cavity correctly, the electrician to know how to install a light fixture in a safe way, I expect my GP to understand and be able to explain the risks and benefits of his suggested treatments, so why should I expect any less from my psychiatrist?

Emma,
Of course. I have always explained the risks and benefits to the best of my knowlege and the information available at the time.

Would you fault your carpenter for building a house that got eaten by termites because termite resistant materials came on the market later? Old electrical code is not safe by today’s standards. Old cars lack modern safety features. New information comes up in every field.

I think that’s it’s true that another form of a drilled hole in the bucket is the one distracting you from who you are by making you hate the psychiatrist so much that that’s the new distraction you have after you thought you needed a magic pill. Is hating the psychiatrist going to make you feel better, which is why you thought you needed help in the first place?

And come on Alice, the only way you can compare psychiatric medications with electrical work is like saying that when there’s a warning signal going on that you cut the wires and say it’s fixed. That takes care of the alarm, and temporarily makes a person ditch their anxiety (which actually had a function, even though it was apparently annoying); but it doesn’t fix anything really; unless you want to say there was something wrong with the anxiety because this points out something is wrong and it bursts a bubble. I suppose that I would have wanted the latest financial bubble that burst to keep expanding: houses acquiring more and more value, Wall Street Tyke-coons as happy as kids in a candy shop, booming bloomin economy. But if that kept going the way it was, and such exploitation of resources for fantasy fulfillment was supported (with resources from at least 20 more planets, as if this would be possible); somehow I think the Universe would fall apart.

You can also take the bucket off, and one can pretty much be assured it has enough hole in it that you can hang it up, pour water in it, and have it water your garden. I’m going to do just that, and it might help with that inevitable alien invasion we can expect, thanks to the bubble!

Spending a life being angry at or hating anything can become a life defining “hole in the bucket”. My theory is that, with practice, you could make a “love” hole instead. It seems a more a pleasant one from inside, maybe from the outside. I’ll let you know how it goes.

I’ve been thinking more about the “bucket metaphor”. I notice a big “cultural” bucket sometimes. It seems there’s a lot of anger in our country. Maybe I’m wrong here.

Okay. No electrical or carpenter metaphors. Where did it come from anyway? Sorry.

Alice, I think that when a therapist helps a person let go of fear (I know you mentioned you do cognitive behavioral therapy) then they are helping to make electrical connections in the brain. You are rewiring your reflexes so that they are in working order. But here this rewiring happens all by itself when you let go of fear. No one really does it, or we all do it together because it’s what being human is, really . That’s our connection. To let go of fear and not judge. To live. When you think from that level, there’s no loss. You don’t wear out any nerves in your brain, there’s no difficulty processing things. You don’t lose anything when you give from a level where there’s no loss. Building a society from such love doesn’t entail loss. There’s no loss when you restore people’s trust in being human, except that you let go of fear, and instead have people that aren’t controlled by guilt. You don’t end up with a society that runs on fear and bankrupts everyone with guilt. What created the Universe? Was it trying to control people by traumatizing them using fear, or was it love? And letting go of fear will do things that science would say is impossible. And you don’t end up with people in the margin who are then deemed not good enough for this society built on fear, and who can’t adapt to it and are supposed to believe they are unworthy. And it’s the people in the margin that actually have the imagination to see what a society really is and could be and will be. They’ve experienced enough to know what doesn’t work, and aren’t fooled believing it does, when it doesn’t. To not have adapted to a society that runs on fear and doesn’t work, isn’t a loss, although such a society tries to traumatize them into believing it is, and when they’re not controlled by trauma they’re called crazy. But in that empty space, that void, their imagination can animate something that would work, because it’s already part of the reality that’s creative, even though this is called a disease, a mental illness.

Nijinsky,
Thanks for another lovely sensitive post. I like cognitive and behavioral approaches to helping people feel better and suffer less. Thanks for remembering I said this.

This is where I spun off from what you wrote today:

Any repetitive thoughts or behaviors (including feelings, words, physical movements, marketing, visualizations etc) will re-wire your brain at any age. This is the miracle of our neurology. This is big to me. You can put in new wiring in your head with music practice, repeated affirmations and repeatedly summoning up emotional states (just to give three random examples).

Any time. It’s never too late.

Replacing fear habits and anger habits with other more positive feelings will “re-wire” (electrochemical and structural) your brain.

Chronic fear and anger wears us out (bancrupts us) from physical, spiritual, cognitive and emotional respects. Did I miss one?

Our culture in America is largely fear and anger based. Fear turns to anger. The media hammers it home and then we hammer it home on ourselves and those around us.

Scared and angry people are easier to control than calm thoughtful ones. There are 311 million of us to control here in America.

When we let ourselves be habitually angry, we are handing the keys to our freedom over to someone else that may not have our best interests at heart.

Alice I have to stress that it’s not about neurology really. When you teach people to let go of fear you create new neurology, but you also create new neurology when you teach people to invest in fear. You create new wiring when you have people indoctrinated with TV commercials: little butterflies lilting around advertising the latest anxiety prevention drug. I was talking about letting go of fear. This way you can even rewire the faulty wiring created by the commercials, social peer pressure and the habit society has of believing that traumatizing people creates the means to control people to create a harmonious society, and then you need something to dope you up when this ideology isn’t working, which it never does. It’s not about neurology, it’s about letting go of fear. Letting go of fear is about allowing the brain to make the connections that are natural for it; that involves neurology; but neurology can go either way. It could be brainwashing or it could be letting go of fear. One is real, the other isn’t.

No, you didn’t. The fact is that others DID know the truth. They paid attention. They cared first for their patients. As a result, they looked at what the drugs are, at how they were approved, at the effects they have – and they refused to go down that path. They’ve written about it, complete with supporting documentation – and they were writing about it before you started practice.

Any doctor, in any field, who is unaware of the harm done by their treatments is choosing to wear blinders. And frankly, there’s no excuse – because the information is, and has been, out there for a long time.

It’s your job to know.

The anger of people who’ve come up against this system that discounts them, treats them like filth, discards them, forces them into treatment they don’t want is certainly understandable. As a psychiatrist, isn’t it your job to try to understand that anger, not to trounce it?

Your statement that we’re all in this together is simply not true. YOU are not in this with the people you treat. Even your responses to people’s comments make it clear that you don’t think of yourself as in it with them. You speak in a condescending manner. No, we aren’t all in this together.

Anom,
What were you hoping that I (or another) would say or do? Is there a specific set of words you await?
I’m curious to understand exactly what you are looking for and the changes you hope these things would make.

The part about how I ran my professional practice. Wrong. You weren’t there. You’ll have to take my word for it. Or not.

The other part about us “not being in this together”. There’s some truth in that. I’m here “in it” because I thought there may be a “snowball’s chance” of me helping make things better with words. You can stand a little further way, if you like, while I try. Me and you being together to work on making things better? You get to choose.

When taking at face value the studies done by pharmaceutical companies, those studies from the last 30 years showed that most psychotropic drugs would usually only help 10-20% of the patients. Where or by who did that conclusion from pharma studies got distorted into: “a common problem with mental treatment is patient compliance” and “mental illness is easily treatable with drugs”, while doctors were provided repeated evidence by pharma itself in each of their studies that 80% of drug patients would only get side-effects.

I wonder if you could be more specific about what doctors in general don’t know or don’t say:
– doctors don’t know numbers-needed-to-treat of the drugs they are using? (or similar effectiveness numbers)?
– doctors don’t think the patient should know about the trade-off/uncertainties involved in their treatment, or have a say in choosing their treatment?

I do believe most doctors are genuinely caring (and they have a long scientific training), which is why I would be curious to more precisely identify the mechanisms where information got lost/distorted after being published in medical journals (whether the published information was correct or incomplete or manipulated is another question, I am mostly concerned that the results of medical journals does not match what is told to patients). Should we teach more math in high-school, in medical school?

Stanley,
I was taught that “all antidepressants work 80 percent of the time to relieve the symptoms of depression”. “Each medicine works on a different group of patients. So if the first doesn’t help, the second has a good chance of helping.”

I was taught that antidepressants had few and mild side-effects and no withdrawel.

Each new “indication” for them was presented as a gift to help suffering patients. ex.”SSRIs releive anxiety”

The information you refer to was not “out there” at the time. The above information I quote chapter and verse was repeated a thousand times in every professional conference and magazine and continuing education I attended. This drilled my bucket holes.

I’m not a math wizard. Never have been. But 80% is a lot of help isn’t it?
Thanks for reading and commenting.
Alice

How come so many of us in the system knew this stuff a long time ago and the psychaitrists didn’t? Dr. Martin Harrow did a 15 year study about how people suffering from psychosis for the first time had remarcably better recovery rates than those put on meds. He just published his 20 year study this spring. Granted, the journals etc. are controlled by Big Pharma and it decides which articles are going to be published so it’s very difficult for people with information such as this to get their information out to the public. And the media won’t cover things properly, and even the NIMH didn’t mention Harrow’s studies. But, if those of us in the wonderful system were able to get the information why couldn’t the psychiatrists? I don’t have every psychiatrist, but most of the ones I’ve worked side by side with as a chaplain and the ones who supposedly treated me, were absolutely awful. Maybe I just have really bad luck when getting stuck with doctors!

If he just published the 20 year study this spring (2012?)this would have been too late for me to read in 1983, or 1993 or 2003. How would I, or anyone out there, have heard of this? I still hadn’t till the past couple of weeks.

You certainly are on to something important here:

“the journals etc. are controlled by Big Pharma and it decides which articles are going to be published so it’s very difficult (read impossible. The information legally belongs to the one that paid for the research) for people with information such as this to get their information out to the public. And the media won’t cover things properly, and even the NIMH didn’t mention Harrow’s studies.”

I learned back in training (believe it or not) that 1/3 get better, 1/3 stay the same and 1/3 get worse or people with the diagnosis of schizophrenia in a big long term study. This is old information. I heard thatbck then. You don’t even hear this older information in the ever increasing flurry of drug funded marketing “education”.

Most medical doctors wouldn’t be able to design a study based on the knowledge they have from med school. They have to dig pretty deeply in the journals to find that the sample was too small, or that the significance of the effect is minimal, or that subjects dropped out of the study, which make the results meaningless.

They only have minimal training in research design, unless they go into a research rather than clinical field.

Most practitioners don’t have the time to delve into this, and the drug reps explain it to them in much simpler ways, over lunch.

Perhaps you have read some of the old social psych studies, such as Milburn’s study on peer influence, which is being replicated even now to show just how much we “group think”.

We like to think we are independent thinkers and that we could hold our own in an argument. We like to think we could stand up to authority while we are in training and blow the whistle on anything that seems to be out of order and bravely risk losing our funding, scholarships, or career.

It took a journalist, Robert Whitaker, not a psychiatrist, to finally pull the rope. Except for Breggin, Lainge, and Szaz, who was considered just as flaky as his patients.

My akathisia and tardive dyskinesia are just minor consequences to the prescribers.

TD was described as “nothing to worry about”. Another said ” the benefits outweigh the risks.”

I have had two psychiatrists who were also pharmacists and held in very high esteem by everyone who met them, because they “really know their chemistry”!

This brilliant MD, PharmD explained how much better my life would be on Clozapine. “you’ll sleep so soundly that you might drool, but you just keep a towel next to your pillow”.

He didn’t tell me about being so out of it that I would almost lose my job and gain nearly twenty pounds in three weeks.

It’s more than advertising, it’s putting trust in someone who doesn’t know you, doesn’t care to get to know you, and to whom you are just a number, another “case” that he may never see again. And a culture that puts these people on a pedestal.

I guess what I am taking from Dr Keys that is most important is “we’re all in this together” and I will not lump her in with “evil” doctors “knew” yet did nothing to stop it. (such as Dr Daniel Carlat).
I honestly believe that they were fooled as much as the rest of us. We wanted to believe these were miracle cures, and there were egos, money, laziness, fatigue, time, deadlines, paperwork and many other factors involved.

Marianne,
Thanks for your support. I’m sorry you have suffered so much.

“Most medical doctors” don’t do research.They work in the clinical office with patients. Research is left in the hands of the medical schools and academics or the “research for hire” clinics that do just this all day.

Most medical doctors are not trained or exeprienced in research. It is very expensive and time consuming and would not allow time for patient care. We generally choose one path or the other. Research findinbg must be found and generally is.
Thanks,
Alice

A personal note,
Alice, I have suffered a lot at the hands of psychiatry, and it seems that I am complaining a lot, and over personalizing eveything.

I have to keep stepping back and reminding myself not to do that, however when I read my own posts they sound whiny.

I have learned so much through that “suffering” and it has made me a much stronger person.

My wish is to turn all that experience into something good, and I have been doing that, a day at a time. I don’t want that suffering to have been in vain, so I have to find a way to “give back” as Erick Erickson describes this stage of life.

I have forgiven all the shrinks that have harmed me. There have been some good people along the way who helped me in untold ways even though they were also fooled by the psych machine, they did their best with what they had.

I want no more bitterness and anger, and I have learned to pay attention to red flags, or the “gut feeling” I get when I don’t trust someone. It isn’t paranoia, it’s a sixth sense or a self protective intuition.

My gut tells me you are trustworthy and open minded. I will go with that, and do my best not to be a whiner and a complainer!

On a website like this we are all driving blind. I never see get to you and you never get to see me. I’m out here with my real picture and real name. That’s as good as it gets.

To be honest, there are times I forget everyone here is driving blind. I wonder, how could they think this about me? How could they say something like that?

I have to remind myself that no one here actually knows anything about me except the words I type. It’s likely people have a lot of hurt and anger from bad things that have happened somewhere else and some other time. I want them to feel better and suffer less.

I’m here writing because I wanted to see if one voice could make a difference. I’ve read all this philosophical stuff about a butterfly wing on this side of the world resulting in a typhoon on the other side of the globe. I’m a believer in peaceful cooperative approaches to change.

this is an interesting metaphor Alice and I am sure it will generate lots of comments!
I am not a psychiatrist but am a Master’s level ‘clinician’ with decades of experience in the mental health ‘system’. i’ve only recently (in the past 10 years) had the courage/maturity to really question the ‘status quo’ within the system. I’m one of those who used to believe the ‘schizophrenia is like diabetes’ mantra simply because that is what i was taught/told and almost everyone used THAT metaphor as a means to convince people to take their medications!! I have guilt about being so UNinformed but am also mindful of how difficult it is to change popular beliefs and/or long held understandings of things.
i love this quote as I think it sums up some of our human experience and may explain a bit of why we sometimes have our head in the sand!
“It’s what we think we know that keeps us from learning” (Claude Bernard)

It is about marketing being given more money than science. The science has said that good social support is more important than any drug and that horrible, scary things drive people mad. But marketing dressed up as science is what has driven this.

It took me a long time to have faith in what I believe, that the drugs cause more harm than good in most cases and that what people need is social support. I had to do a lot of reading, go to a lot of conferences and check all this out with my own personal experiences of talking to people in distress and seeing what helped along with looking at my own life before I could sally forth into public debate with confidence.

I was lucky, I had some training and some experience and I had read a bit before I met my first seriously mad person and found out that compassionate understanding worked and it was obvious that the drugs did not. An awful lot of those Dr’s and other staff have been taught that it is dangerous to offer compassionate understanding to people hear voices or are experiencing things that might get them diagnosis of schizophrenia or bipolar. So they never see the things that counter what they have been taught at college, got employed to do and hear all around them at work. that is an awful lot of indoctrination that would need to be countered to change most professionals minds.

That is why I think this is not a one at a time sort of struggle. It is about being organised, finding allies and working out what small or big thing can groups of people do to challenge big pharma and mainstream psychiatry.

John,
I am so happy that you got what I meant to say. Marketing is BIG and marquerades as education all the way down to infancy in our country. This is about MARKETING, not science.

One of the reasons I am writing here becasue I finally got it that there’s nothing I can do as an isolated doctor drowning in the trenches. The laptop is mightier…

This will take a lot of efforts by a lot of people from all walks of life to make better. We may even need to let some of the (I’ll whisper this) psychiatrists in on whats happening. We’re all in this together.

One of the last forms of authority which remains largely unchallenged and unquestioned is medical authority of any kind, no matter what the speciality. Psychiatrists don’t really get a lot of specific training anymore, since psychotherapy is out of favor. They’re basically taught that the meds are great and how to use the DSM. I’m not a psychiatrist, but in talking with a number of interns and residents, this seems to be the gist of their training for psychiatry. It’s really kind of frightening to me how uninformed they are about so many things. However, I don’t think this absolves them from doing their own research and questioning and digging into things to see what really is going on and what really happens. Let’s face it, they’re not trained to question much of anything and if and when they do they get the boom lowered on them. If they continue to question, they don’t go very far in the profession. However, once again I will say that I don’t believe that this absolves them from trying to know more. After all, they have people’s lives in their hands and are responsible for their well being. Many of them are not doing a very good job at all this at this point in time.

Stephen,
Psychiatry training is DSM and drugs. Yup. That’s right. Education is funded by pharmaceautical company dollars. We’ve long ago voted out state funding of teaching hospitals. Does anyone else even remember when medical education was state funded and the trainees took care of the poor in exchange?

He that pays the piper gets to call the tune.

How can we expect that doctors in training, enslaved with education loans and exhausted by long hours, to know better and save us all? It’s a lot to expect of another person.

Your bucket analogy is just like how cells in the body work. The “holes” are specially designed to let the right “signals” in and keep out the wrong signals. Nature is exquisite in that sort of design, refined over eons.

So, given the analogy, and that the metaphor is actually working the way it should… what’s missing? Are we drilling the wrong holes? Maybe we should put the drill down, and leave Nature’s own holes be… learn to use the perfection of what we are/have?

Or are we just mis-feeding the bucket… or we’re starving and will let any nutrition in, even if it’s killing us (like drinking salt water when adrift in the ocean).

How can we create a nutritious environment for our buckets? And how can we clean our buckets of all the crap stuck in some of our holes? Bless and release it, so to speak. We do this on a cellular level when we release trauma. How can we do that on a mental level, too?

Keith,
So many questions and so little time. Thanks for “getting” the metaphor.

How about we take the drill out of the hands of the drug companies for starters. Even New Zealand finally did. Outlaw marketing of drugs to the public. Get the “free” samples and drug reps out of every doctor training location. Big financial conflict of interest disclaimers on the DSM and PDR. “Diagnostic criteria brought to youby the makers of… )

I had worked for decades before I relaized the PDR is a paid drug marketing catalog. Doctos BUY this thing for the “i” things now.

Alice you could have known the same way many of us have known for decades- by taking seriously the warnings of fellow psychiatrists like Jung, Perry, Laing, Menninger, Mosher, Silverman, Szasz, Breggin, Dan Fisher, Peter Statsny David Healy and many more. Why did you ignore tiheir clear warnings?

Dr. Cornwall,
How often are these “clear warnings” a part of medical education? How often are they a part of psychiatry training. HOw often are they a part of every day life?

I have had to stumble upon each of these one by one over the years through wide personl reading.

Everyone of us is unknowingly programmed by those things we have the most exposure to, what’s right hammering the air in front of us. Repetition. For warnings to be warnings they have to be visible and audible.

Every single one us us has our own invisible “head-bucket” filter. All of us.

The fact remains, some people chose to question this paradigm of care many years ago. For years, you did not. This is okay. You are human. We see and hear those truths which challenge our egos when we are ready.

The sticky point for me is that you assert your story as if you had no choice. No agency. You were a puppet, according to you. I don’t buy it. You had agency. Why not make peace with that truth?

As a psychiatric survivor, I had choices. At 16 years old I could have refused the drugs, even though everyone advised me to take them. I was mislead, yes. I still had a choice. It is up to me to take responsibility for this choice, and to expolore it means to me, and what it meant about me at the time. What was the ‘payoff’ so to speak??

Vanessa,
Every step of the way I studied the research that was available to me. I was motivated by a desire to help others. I believed what I was taught because I had no reason to question. I had respectful relationships with the patients I treated. I offered choice and the information that I had to share. When I had questions about things, I shared them. When I came across Robert Whitaker’s book at the library, I read it. I went back to work and shared what I learned. I changed how I worked. Then I left. Now I write here to have a bigger impact.

When the information was available I read it and changed.

I think the part where I feel like I was given no choice is the part where the research was hidden, surpressed and lied about and I believed it. If I had the information back then that I have now, I would have made other choices. But I didn’t so I didn’t. Isn’t the “retrospectroscope” great?

I’m actually fine with the choices I’ve made over the years. Each one was made based on the best information I could get at the time. Who could do better? A psychic?

I’m advocating for a more tolerant and understanding attitude toward the psychiatric profession. I understand that a lot of folks have had bad experiences with psychiatrists. But I imagine there may be others that have been well-meaning and done the best anyone could do with the information available at the time. We need these people here in the discussion. When people shoot at every psychiatrist because they were hurt by one once, it can be counterproductive to the goal of making things better.

We are all in this together.
Thanks for reading and thinking and writing. We need you as well.
Alice

Naw not me is right Alice. I never drank the koolaid that said human emotional suffering and madness was what psychiatry says it is. Is that so hard for you to imagine? That someone could have a visceral reaction of revulsion against every core dogma of psychiatry that makes possible every abuse and human rights violation done by MD’s.? Like now – ECT on toddlers under three, babies 18 months old labeled bipolar and on psych meds. I’m glad you have finally seen the light and are not going to be on the wrong side of history- but please don’t assume many of us haven’t been on the right side from day one.

Dr. Cornwall,
I only assume you have a cognitive filter like the rest of us and maybe don’t see your own holes any better than the average bear. But I don’t know you so I could be wrong. It wouldn’t be the first time I was.

Tell us more about the job you worked at for thirty years where you knew psychiatrists. Did you have a separate solo private practice or were you a member of their treatment team? This could give me a bit more understanding of where you’re coming from and how you could have spent all those years not drinking koolaid.

I wonder if there were ever a psychiatrist who ever did an act of kindness and caring for a patient. Yes. There is evil afoot. But every psychiatrist is not always evil. All or none, black or white.

By the way, my mom used to put koolaid in my bottle as a baby. I liked the green.

All the best always. Me and you. We’re not so far apart as it may seem.

Check out my last blog here Alice, “Are Some Psychiatrists Addicted to Deference?”- where I share about standing up for the people I served when psychiatists were not acting in their best interests- me speaking truth to power instead of me not drinking the koolaid-
and my blog-“Eyewitness to the Ruination of a Public Mental Health System”- my almost thirty year account of not only refusing the koolaid but engineering the job loss of several top administrators who tried to force the medical model btrain disease koolaid on the line staff and the people we served.

Doctor,
I read the “Deference” piece. Commented. Will get around to reading the other after done here in comment land.

So you were never a paid a member of a multidiscipinary treatment team? You spent all your career getting everyone off the evil drugs? You never saw any person’s life on medicine work better than without? Never wrote a diagnosis on a piece of paper for anyone, not even so they could get on disability?

I don’t quarrel with the battles you say you’ve fought and won. Good for you.

Tossing the phrase “drinking koolaid” around with regard to my professional life sounds like you may be referring to the old LSD experimentation days of psychology. Those days were gone by the time I came along

Class of 1-
I have never referred someone I was seeing in therapy for medication management. If they came to me on meds, I would work with them and their psychiatrist to get them off if that is what they desired. Please see my blog here- “Responding to Madness With Loving Receptivity: A Practical Guide” to see how it is possible to serve people without diagnosing them or medicating them.

Thanks for the great book title! but it would be only half the story- Alice and I both know how privelged we are to have the great opportunity serve- so gratitude would have to be in the book title too!

Thanks for the answer. I must say I’m impressed. What I’ve seen and heard is that it’s not just psychiatrists that have the problem believing in pills as an answer. The mass marketing of pills in all forms of media has social workers, psychologists and the patients themselves pressuring to be prescribed medicines. This pervasive mentality of a pill to cure any ill needs to be corrected. Lets get the advertising banned, require drug companies to report all testing, not just the select positive results, remove drug company funding of education, and see if a better balance emerges.

Perhaps, Michael, in the case of Laing and Mosher at least, the part of the warning that some heed is that they died frustrated and at least a little bitter. Sure; they had the satisfaction of seeing the beauty of their beliefs realized for a time, but frustrated at the reception they were met with moving forward.
Szasz, as lauded as he is by us, is a pariah in his profession. Healy is a pariah even on this website. Stastny soldiers on, and I won’t speak for him, but I know it’s not easy. It’s a lot to ask someone to take on the mantle of the people you mention. It’s no mean task. To create a space where the kind of work their beliefs imply is embraced and sustainable is almost a magic trick. Dan Edmunds wrote today (in a response to a query on his blog) about his short-lived therapeutic community running out of funds, and sustaining his med-free clinic out of book sales and his own personal investment.
Dan Fisher, coming from the “peer” side of things, finds brilliant ways to mobilize that interest; but as for creating services for people who are not yet identified or don’t wish to be identified as part of the “peer” movement; if you charge enough for it to be sustainable in a system that won’t support it, you are pilloried as mercenary by the people you need as allies. And everybody arrives at the door exhausted of spirit and treasure by the system we decry, asking to have the wrongs righted without having to spend more.
So maybe it’s a matter of which warning people heed at a given time. How many times, and how hard, do we expect any one person to beat their head against a wall? I know beautifully intended, spiritual and holistically-minded people who went to psychiatrist school to be one of the ones who changed things, only to emerge beaten and bedraggled, with kids to feed and educate, and little margin left. Their spirit may be willing, but their too, too solid flesh is weak.
I say this, Michael, as you know, as someone who is wont to dive in heedlessly if there’s a chance of making good on the promise of the names you mention. But I am not constrained by college debt or the potential loss of a license, tenure, the kids’ college fund, or anyone’s respect. What I lack in stature I make up for in stealth.
Even so I have empathy for people who have something to lose. I (and many others, yourself included, I believe) really appreciate Alice putting herself and her process out on this website. To suffer the slings and arrows of outrageous criticism, standing out in the open with a bucket on her head, deserves a moment of appreciation.

Kermit, I’m responding to Alice’s archetypal question that is haunting a vast number of psychiatrists today. It is a core question now, because of the looming judgement of psychiatrists in the court of public opinion that has been greatly stimulated by Bob’s- “Anatomy of an Epidemic.”

Alice’s question- “How could I have known?” has prompted me to attempt to answer it.

The question is one that may be heard asked by a psychiatrist in a court room, if it hasn’t been heard already.

I have a friend who is a very caring child psychiatrist who I can imagine might be having a recurrent nightmare that she wakss up from in a cold sweat. In the dream she is in court, standing before a judge, trying to explain to him why it is not her fault that the psych drugs she has been prescribing have caused one 8 year old child to hang himself, a toddler to have died of an overdose by negligent parents trying to get her to be quiet so they can sleep, and the third, a teen boy on Prozac who stabbed and killed his best friend.

As you know, all of these tragic deaths really have recently happened, and the courts have ruled that psych drugs were a factor or fully responsible. Psychiatrists have been punished.

The handwriting is on the wall. I have a friend who has decades of experience as an advocacy lawyer who predicts it is only a matter of time until the Justice department escalates it’s oversight of the dangers of psych drugs, given the recent huge J&J Risperdal settlement.

He ststes clearly that many of the practics of psychiatry, such as the wholesale drugging of toddlers and children, ECT of children and forced ECT and meds on adults,- all qualify as human rights abuses.

MIA blogger Jim Gottstein says they are human rights violations too.

I believe that more psychiatrists are heading to court and the defense of-
“I was only doing what the APA guidlines and the drug label warnings said was OK,- this child’s death is not not my fault!”- has already proven to be a losing defense.

The Nazia on trial at Nuremburg tried the old,”I was only following orders” plea and it fell on deaf ears all the way around. They were hung by the neck until dead. As a nursing home chaplain I got the wonderful and great privilege of ministering to one of the lawyers who tried the Nazis at Nuremburg. I doubt that he would let psychiatrist escape if they tried this excuse on him!

Stephen,
Back to nazi rhetoric here in comment land?
Will this further peaceful discussion?
Will this lead us to solutions or simply through fuel on anger and kill thought?
What’s your goal for participating in the discussion here?
Chaplain? Man of God and peace?
Oops. Too many questions.
Much love,
Alice

Alice gets more than a moment of appreciation from me Kermit, and already has in other posts- I admire her courage and caring heart a great deal. As they say where I’m from- “I’d share a foxhiole with her anytime!” meaning I count her as a comtade in the struggle.

And when she asks a serious question of us like-“How could I have known?” I believe it deserves an honest answer – for what ever my answer may be worth.

It is probably easier to see the errors of psychiatry if you have had a breakdown yourself at some time in your life and recovered. The fact that I had had one myself helped me to stand up to my son’s psychiatrists who thought they knew it all

Arta,
In a similar area: As a new medical student on my first clinical rotation, one of my first medical patients was a doctor/teacher from the medical school. He had terminal metastatic liver cancer. This really got my attention about mortality and banished any young illusions I may have had about fighting death and winning.

There’s nothing like experience. I have know several psychiatrists that were hospitalized for psychiatric reasons over the years. I can’t speak for the impact this must have had on their practice. I’ve also worked a lot in A and D treatment. The thought from those working in the A and D field is that I can’t “get it” till I develop an addiction and go through the recovery process. However, I have known very good counselors who were not in recovery themselves.

Alice the term drinking the koolaid comes from Jonestown. When I say I never drank any harmful biopsychiatry koolaid., I mean i never believed in or practiced therapy with the mindset that madness and human emotional suffering are diseases. please see my blog -“I Don’t Believe in Mental Illness- Do You?” and you will better understand why for many of us the medical model has never been part of our belief system or practice,

This raises another interesting question: are doctors scientists? Someone commented that doctors have a lot of training in science. I’d have to say that I question that to a degree. I think doctors have a lot of training in the conclusions of prior scientists, but not necessarily so much in how to conduct their own experiments. It seems to be more a matter of the current orthodoxy spreading their views and expecting their trainees to jump on board. Real science is about skepticism, about questioning your own conclusions, about always seeking to know more and to see things differently. Something is regarded as “true” only when it’s been rigorously tested, including rigorous attempts to find a flaw or contradiction or a better explanation that fits the facts.

It is obvious that psychiatry as a discipline does not apply this kind of rigorous scientific training to their concepts. The whole idea of a “chemical imbalance” has apparently been solidly disproven, at least as far as serotonin for depression or dopamine for psychosis, as early as the mid-1980s. But rather than reconsider their paradigm, they have chosen to bury this information or state that “further research will validate our theories.” Same with the long-term outcomes for stimulants. It’s been known since the 80s that there is no long term benefit for stimulant-treated “ADHD” kids. But the statement is always, “We have not yet demonstrated a long-term effect.” Well, if you haven’t demonstrated one, from a real scientist’s point of view, we have to assume there is no effect until proven otherwise.

The point of science is to remove the bucket. I think the analogy is very appropriate, and I am glad Dr. Keys has gotten hers off of her head. But most of psychiatry is very attached to their particular brand of bucket and are not really looking at the science. I think they call the DSM the “psychiatric Bible” for a good reason – there is a lot more in common with religion than with science.

The assumption that all doctors are scientists is one that we can no longer afford to make. It would appear that most of them are neither skeptical nor open-minded and are married to their theories. Understanding that may be critical to your survival!

By the way, I so appreciate Dr. Keys’ candor and personal vulnerability in posting here. So I’d like to respectfully ask you a question: if the bucket is the problem, what do you suggest is the best way to remove the bucket from the heads of those who seem to believe their particular bucket encompasses all of the reality they are willing to experience?

I mentioned that psychiatrists are considered doctoral level clinician scientists. I think given their actual training and how many psychiatrists practice, I don’t think psychiatrists are particularly well trained in research methodology and critically engaging the scientific literature (particular in psychological/behavioral sciences). I think doctors are given a lot of deference for their supposed scientific knowledge. In some ways this esteem/prestige afforded doctors helps in healing processes due to enhancing placebo, but ultimately it undermines quality science, gives doctors inflated senses of power/helpfulness, and disempowers/dupes patients who are taught/expect to trust physicians. Psychiatrists have a limited quality evidence base to draw from in regards to effectively explaining and alleviating distress, but that does not stop them from having several elaborate fictions and unsubstantiated theories of etiology and overconfidence in treatment methods available.

This is exactly what I’ve been saying for years now; way too many doctors in every speciality are very arrogant and disrespectiful and some don’t even know what they’re doing. It is all doctors who need to evaluate their work, not just psychiatrists. I worked for over fifteen years alongside all kinds of doctors and because of their attitudes and assumptions about themselves I wouldn’t let them treat my cat, or me! Alice is absolutely correct in stating that all doctors must pass muster and not just psychiatrists!

None us us can take of the bucket completely. It is the operating system sorting for us. The best that can be done is to take the drills away from the pharmaceutical companies. Get the adds out of magazines, television and internet. Get the sweet drug reps and their “helpful information”, “patient training” and “free samples” out of all doctor offices. Unplug the drug cash.

No fast answers here. There is not way to change our heads till we change the messages.

Alice, Thanks for a great post. I want to say I really respect and value your writing this blog. Not everyone has the guts.

And it’s exactly like you say: we’re all wearing a bucket. Society-sized ones, too. In hindsight, it’s easy to say we should have known, but how could we have? We knew the scientific literature. I can’t see what else a psychiatrist or anyone (other than a cutting-edge researcher) could reasonably be expected to have done other than looked at the relevant scientific literature. Nobody assumed the system could be so corrupted you couldn’t trust the big picture in the peer-reviewed literature. So now it turns out we really should have — but at the same time, it really is insane.

So a huge thank you, Alice, for doing this. I’m not a psychiatrist, but you make me feel I’m not all alone. I had no idea either, and we’re all in this mess together.

It isn’t only about being misinformed by the relevant scientific literature but rather the “turn a blind eye” approach of ignoring the obvious signs of the severe side effects caused by psychopharmacology. Where does the research literature state that stimulant medication to treat ADHD can cause the “unmasking” of early onset bipolar? It doesn’t but that is the myth generated by the psychiatric community. Set the record straight instead of making excuses!

Michelle,
I don’t prescribe simulants for anyone at any age despite the big demand (generated by marketing to the public) for them at all age groups.

I have been told repeatedly that “stimulants unmask early onset bipolar” by drug sales people (that the employer allows in) that corner me, by the clinical staff that have been to the drug lecture lunch, by required continuing medical “education”, by the PDR (before I realized it was a paid ad catelog). I never bought this. It’s speed, for goodness sake.

I have also been told by a drug rep over and over about a type of depression (that doesn’t exsist even in the DSM) that should be treated with her antipsychotics. I have had to be less than polite on more than one occasion to make her go away. High energy emotions power the drill. I remember the days, the person and the lies. I didn’t buy those either.

Try “generated by the pharmaceutical company marketing campaigns” in place of “by the psychiatric community”.

Because they outnumbered the patients, took up all the parking spaces and made the waiting room crowded and the doctors behind schedule…just wanted to stomp on them.
Not intended to be a racial/ethnic/minority slur.

Altostata,
Thanks for another enlightening post. I’m glad you figured all this out through self-education. The real task today is finding ways the message can get out. I fear that your “big stick” approach may run off the folks that need to hear.
Best,
Alice

It’s every professional’s responsibility to identify and admit the liabilities and limitations of his/her ‘knowledge’. As an ex-patient I can say, “We don’t know for sure…here are some possibilities” would have gone a long way. Doctors only needed to admit that they practice in a field of study which, like all other fields of study, has ALWAYS discovered and revised its narrative, dispensing old “truths” and inventing new ones.

It’s unbelieveable how many times I was told, “your medications could not possibly cause ‘a’, ‘b’ and ‘c” but depression, fibromyalga and chronic fatigue syndrome do…so…here are more medications, and try some ritalin to keep you awake.”

Peoples’ lives have been forever changed while doctors cashed their checks. Psychiatric survivors live with damaged brains and bodies. Many must wake up every day knowing that years of our lives have been lost to bad medicine. So, quite honestly, I feel okay with doctors working through a little guilt.

I must say, it’s maddening that you recruit sympathy on this site, and liken yourself to the patient. I have worked hard in life, personally and professionally, to listen to people, to connect with them, to investigate truth, to be honest about what I know and what I don’t. I work hard to look beyond the simple answer and its promised shiny object. It’s a decision.

Recruiting a more tolerant and open-minded approach to one another is. It will take all kinds of people, maybe even the occasional psychiatrist, to get this boat turned around.

If the goal is to re-make mental health care into something that works better, then more understanding of one another is in order.

“I have worked hard in life, personally and professionally, to listen to people, to connect with them, to investigate truth, to be honest about what I know and what I don’t. I work hard to look beyond the simple answer…”

This sounds like it could be a quote from how I’ve run my professional life. Perhaps we are more alike than you imagine. Turn the bucket and tilt it just a bit. You may see me, yet.;-)

Your comment that it might ‘even take a few psychiatrists’ to ‘turn this boat around’ is a bit snide, and implies that I challenge you simply because you are a psychiatrist. That is not why I take issue with this post.

What I challenge is your metaphor which, quite honestly, seems like a short-sighted attempt to make peace, save face, and avoid feeling the gravity of your life choices. You call yourself a victim of a broken system. In part, you are. But you did have agency. So before you try to get people to understand you, go deeper with your self. Explore what you got in exchange for buying into the system. What allowed you to turn a blind eye to alternate points of view? You can’t escape the fact, as Cornwall points out, some didn’t drink the koolaid. You did.

I say all this having accepted my responsibility as a patient. I had a choice, even as a 16 year old girl, to say ‘yes’ or ‘no’ to meds. I accepted the meds. I hoped for a simple answer. I lived in fear of speaking up. I was ashamed of my own experience. I aimed to please. I could blame this on my parents, but I own these qualities as my own. I am on the lookout for their expression everyday.

When I quit playing victim, I get to know, intimately, something more meaningful, helpful and healing than any “much love” signature or prescription could provide. I know something about my own liabilities.

I think I hear what you’re saying. And I completely and wholeheartedly agree with you on how much reason there is to be angry and disappointed at the whole psychiatric field, especially for anyone who feels they have been personally abused by it. (Even if we all did have a choice, like you say.)

But that said, I’d like to suggest that we might want to be somewhat gentle in our anger towards individual people like Alice, who are courageous enough to actually change their professional opinions after getting new information, and even to step up from within the system and publically admit the information we all thought we could rely on turned out to be so terribly distorted. Most people I know — psychiatrists or otherwise — are not brave or self-confident or informed enough to go against the system. In fact, the people who do, often face being shut out of their whole professional community. Which is why I admire what Alice is doing.

I’m not a psychiatrist, but I also trusted the system. Not because someone paid me to, or because I didn’t care about those who suffered, but because I really, honestly thought the relevant scientific research was the best thing we had we could rely on. I thought it’s important that we know the literature in order to make informed choices. And I still think research is one of the best tools we have to make informed choices — but before I heard Irving Kirsch, Robert Whitaker, Marcia Angell and others make a convincing argument for it, I could never have guessed how much scientific data was buried, how many experimental results were distorted, how many clinical trials were misreported, and how many problems ignored. I’m still completely overwhelmed and flabberghasted that it was possible. I wish I had been smarter, (I wasn’t), and I think it’s important that people understand how much that is to ask. From within the system, suspecting something like this was going on would have seemed blatantly paranoid, even though it turned out to be true.

I can’t image how someone would go through medical school suspecting everything they teach you is completely wrong, that every textbook you read, every lecture you attend, every distinguished professor you hear is completely brainwashed and misinformed. It’s also impossible to go through your professional life reading every book ever published on mental health in order to find out if you’re missing out on something. I think there truly is a sense in which the system has immense, unbelievable power in guiding what we are able to see and think — which is why we never should have let big pharma control all the psychiatric research and shower medical schools with their money.

I think it’s important to remember Alice didn’t make the choice to give academic research to big pharma. Someone did, and that was an amazingly important decision, but it wasn’t Alice. With that choice, most of us had no choice at all, but now we all have to live with the consequences.

I honestly and fervently hope I don’t sound like I don’t hear what you’re saying, Vanessa; I think I do. But there are really, really smart, well-meaning people who truly tried their best and didn’t have a clue — in fact, still don’t. I think we all really need to listen closely to your experiences, Vanessa, and experiences of others here, and to learn from them. And we also really need people like Alice who are open-minded and courageous enough to completely change their views when they get enough new information and go against the system. I know it may sound amazing, but a lot of people won’t. I don’t want to speak for Alice, but I interpreted her suggestion that we also need psychiatrists to turn this boat around to mean that changing the system may require being able to convince a number of people still within it to change their minds too.

And I think you’re right, Vanessa, “We don’t know for sure, here are some possibilities” is a great suggestion when giving anyone any advice. We should all remember that.

Thank you, Jonathan. I appreciate your words, and your respect for Alice’s decision to challenge the system. You are thoughtful, and clearly have compassion for her position. This is important for all of us to witness.

Please understand, I am not out to make Alice a target at which to aim my anger. I truly believe that identifying personal responsibility (past liabilities) is as key to affecting change as it is to forge ahead and re-make the system. This is very different that finding blame. It’s about getting at the root of our own connection to this tragedy. I have done it, too! It’s a useful exercise, surgical in nature, which heals both the individual and the community at large.

Please remember that, just as it is a lot to expect that of Alice, that she ‘should’ have known, it is a lot to expect that survivors will be quick to praise or even accept reparation. Particularly one that comes without attention to reponsibility.

Vanessa,
My comment that it may take a few psychiatrists to help turn things around is not intended as snide. I intended to convey the idea that I believe the system is very broken and requires repair. I mean to imply with this statement that it behooves a movement looking to fix such large and broken things to get together all the help they can. Help could come from unexpected places. It could come from the ranks of those being vilified. I’m sorry that some people have been hurt through the actions of some psychiatrists. Some does not equal all.

I’m certain I didn’t call myself a “victim of a broken system”. Thanks. I’m pretty good at using my own words. Or perhaps I did and I forgot.

Blind eye? If there is no “alternate point of view” being presented then there is no blind eye. There is an assumption being made that information was available and in plain sight. “Koolaid” implies I was too drugged up something, acid?, to see something that was there to see. I suppose if you had been there with me in my training program, in my private practice, in the clinics where I worked you may be able to say this. Until then… I suppose you can say it all you want. It’s a “free country”*.
*(This is intended to be snide)

My biggest personal liability is my habit of trusting what people tell me, presuming good intentions and seeing the basic goodness of human spirit in everyone I contact.

Your habits of ‘trusting what people tell [you]’ and ‘presuming good intentions’ are experiences reserved for those having lived with the privilege of power–via race, class, doctor, etc. If unbalanced by critical frameworks (e.g.feminism, postmodernism, psychoanalyis, psycho-politics, psycho-history and economics), trusting-ness has the dark potential to generate complacency and systemic corruption.

I’d also add that this kind of ‘trust’ is rooted, partially, in the qualities of obediance and fear:

Vanessa,
You make assumptions about how I grew up and my personal experiences that may be incorrect. The “trust” I have has been intentionally cultivated later in life. My own starting point was pretty suspicious, angry and accusing.

We live in a cultural bucket of deeply-embedded mistrust, fear and anger. True stories. I had to rent an electric piano in another country. My language is poor. They had little English. My credit card wouldn’t work because they use an imbedded ID chip we don’t have. They handed over a new-in-the-box piano for 70 euros cash rental and my word I’d bring it back. They didn’t know me and only had a hotel address in another town. When? Last October. Another time, I was on a crowded city street, same other country. A four year old girl raced between our legs with a money in her hand. I was freaked. No one else noticed her. She ran into the news shop up the block and came back with a paper in one hand and her change in the other. She vanished into the crowd behind me. Both these are normal and everyday in other countries.

We are different here in America. Very, very different. Sometimes one must get “outside the bucket” to see things

Thank you for your comments throughout this thread. I am struggling to heal from 15 years of psychiatric care (drugs and shock) which I finally realized was damaging me physically and cognitively while only exacerbating the mental and emotional distress which led me to psychiatry in the first place. Reading what you have posted here is very helpful to me.

Of course I’m angry at the pharmaceutical industry and the kind and well-meaning doctors who believed the propaganda and were unable to offer me truly informed consent. (I’m not too thrilled with the authoritarian, unkind, and negligent ones either.) Nevertheless, I recognize that I am an agent who bears the ultimate responsibility for my decisions about which doctors to trust and what treatments to try. If I, who have no medical training and will live with the consequences of these misguided decisions for the rest of my life, can say this, I think the least we can expect from psychiatrists is to do the same.

What is astonishing to me in retrospect is that I spent many of those psychiatrized years reading critical theory, working in a country brutalized by a military occupation, and congratulating myself on being an anti corporate leftist. I thought I knew a lot about injustice, oppression, privilege, cooruption, etc. but I was wrong. Reflecting on why I was oblivious to these elements in psychiatry has been humbling to say the least.

Thank you for taking the time to share your thoughts and experience. I felt an overwhelimng connection to your story and words.

It sounds as if we have had similar experiences with both psychiatry (including timeline of ‘treatment’ and decline) and the pursuit of critical theory and ‘leftist’ politics.

Thanks for sharing a bit about the process by which you came to reflect on personal responsiblity. I do think it’s important to find a foothole into the realm of fearless self-examination.

Over the years, did you try to come off of the meds unsuccessfully? THis was the trap for me. Even when I intuitively knew these drugs created iatrogentic illness, I could not come off of them. It has been, and still is, an excruciatingly painful process to withdraw and wait for my brain to recalibrate, so to speak. But, like you (it sounds?), I had to. I was only feeling sicker and sicker while my mental/emotional/spiritual state declined. I came off meds AMA. Five months later, I’m experiencing marked improvement.

Where are you in the process? Please contact Laura Delano on this site if you’d like to share your story here, or you can ask her for “vanessa’s” direct email if you’d like to connect.

As people who are survivors and ex-patients we have absolutely no reason to trust any psychiatrist at all for any reaons, until that said psychiatrist proves to us that she or he is worth trusting. It is no surpirse to me that many of us find it difficult to trust psychiatrists who post on here. You have to pass scrutiny before we’re going to sit down as one big happy family. Personally, I’m impressed with you as a person Alice, but I still have some discomfort with your metaphor. People have been telling their psychiatrists for years that the drugs were toxic and were doing great harm and the usual response we received is that this wasn’t true, we didn’t know or understand! We can spot Trojan horses when we see them; so bear with us as we scope you out and evaluate what you say. We are hard on people but I feel that we have a right to be.

Another metaphor coming here (a true story from a friend long ago and how she ran her personal life):

I know I’m on the attack with you but you’re a blond man. After all I was hurt more than once by a blond man. Many people I knew were hurt by blond men once. Those blond men were in positions of power and trust; arrogant, not listening. Some of us were hurt by blond men they didn’t even know very well. Why should any of us trust any blond man anywhere any time? I have every right to call you names because you’re a blond man. Any of us that were hurt or ever heard of anyone being hurt by blond men has the right to stay angry forever at every blond man. Nothing personal. You’re a blond man. You should know better than to be here. Even if I really whack you hard and hurt you, I have the right to. How else will I know if I can trust you?

How can I trust you? You’ve been taking some mighty broad punches for a man of the cloth. Are you “worth trusting”? Why and why not?

Never was a “man of the cloth” as you call it. I was never ordained but was a lay person all the way. Studied for the priesthood but got out before ordination when I realized that they were covereing up the pedophile business.

Stephen,
Perhaps my reply was misdirected. I get things in order of time they are posted, not by the comment thread.My machine refuses to process the scroll view. Perhaps you are not the person who said he was a “chaplain” in a nursing home. That is the only one I recall saying anything like “man of the cloth” to.

Perhaps my answers are going awry when I answer from the “dashboard” mode.

Recently, a psychiatrist in Vancouver, BC spoke at a conference for families of people diagnosed with schizophrenia. She told the audience that since having her own son diagnosed with schizophrenia, she has learned that the meds don’t work for him and have done him harm. This has led her to change her practice: she tries to listen to her patients as if they were equals in their knowledge about their “symptoms” and she no longer encourages meds.

Is that what it takes? If so, shame on doctors for not exercising their powers of observation, smarts and compassion when treating other people’s sons and daughters; for not reading the lists of conflicts of interest on research articles (or reading about the subject at all?); for missing the inequality built into the psy doc and patient and “consummer” relationship.

Usually, when I hear the other person’s side I can get it. But this I really don’t get. My only other encounter with this degree of bucket blinders has been in conservative religion amongst male leaders granted special authoritarian status they and their communities believe to be bestowed by god. It’s pretty dangerous for lay people. Especially the kids.

Diana,
The bucket is big and thick, isn’t it? I find it’s always easier to see when someone else’s is on crooked or has the holes in the wrong place than to see my own.

It will take all kinds of people working together to make substantial changes in the way we handle mental health in this country.

Yes. Some psychiatrists have done bad things.But perhaps you have not yet met every psychiatrist. Perhaps there are some who could make useful contributions here. It would be a shame to run them all off by assuming all are “dangerous”. Perhaps the one that spoke in BC? She changed her practice and teaches others. Could she join in here and help? How would she be recieved?

As with some of the other comments here, whilst I think society overall does need to re-think their “buckets”, the onus to remain objective and *know* what they’re talking about surely lies on the professionals who insist that they alone have the answers, due to their specialist training and knowledge.

My experience of the psychiatric profession was one of blinkered thinking on the part of Doctors, and an automatic dismissal that anyone (myself, my family or my friends) could possibly know the reasons behind my distress, let alone how best to treat it.

I was repeatedly told that I had to be on medication “for the long term, if not for the rest of (my) life”. On the basis, that my depression is caused by chemical imbalances in the brain, and like a diabetic, I need antidepressants, just like a diabetic needs insulin. A profession on my part of faith that this was correct, was pretty much a condition of my discharge from hospital.

If clinicians are going to be afforded such spectacular powers over fellow human beings, to curtail their human rights and deprive them of their liberty – they owe people like me a duty to actually *know* what they’re talking about. In other words, if they don’t really know the answers or the causes, then they have no legitimate authority for locking people up on the pretext that it’s for their own good.

Everyone has their own buckets. But the entire concept of being a specialist profession, is that you learn how to discard/see through it. To date, I don’t see that psychiatry as a whole has any interest in doing so.

Anon,
You assume that psychiatrists are a special and separate breed of humans that are not trapped with the same cognitive system as others.

Oh how I wish it were true that I had special powers to see past marketing and see information that’s been hidden form view. But it’s not.

What you were taught about depression and medicines is what I was taught is what everyone with a television was taught.

We are in the same boat here.

Being given the “right to take away liberty” can be addressed through the courts and elected officials. These laws are made our elected representatives. Remedy for these comes through those channels. The psychitrists, ED doctors, police, mental health professionals are legally bound to comply with the committemtn laws of the state. Laws can be changed.

In the UK CTO’s (the UK version of Laura’s law) was opposed by many psychiatrists. However now it is law it is used by many psychiatrists (I can’t say whether the ones who opposed the law are now using it) and in much larger numbers than it was originally intended.

However laws are open to interpretation. There are practitioners who do not use these laws, or use them much less than others. This depends partly on personal practice and conscience but also on the culture of the team that people work in.

We need the ones who do not use coercion and those who either do not use drugs or use them carefully, with full negotiation and proper informed consent with service users to put their hands up and say they are against conventional practice. I’d like to see, “No Forced Drugging,” badges worn by friendly practitioners as an active part of this struggle

Jen,
In the view that I use here, I see comments by time posted so can’t always track the complex web. If I used the initials “APA” in a post, I would have meant Psychiatric. I have associations with neither organization.
Alice

As to many of the commenter/responders … I think we give too much credit to ‘science’, and are still, collectively, prisoners of the Enlightenment.

In the realm of social interactions, there is actually very little ‘science’ worthy of the name. And for all sorts of reasons, good, bad, and indifferent.

It is very difficult to get ‘gold standard’ studies in medicine (or any other human field) for ethical and other reasons. It is very difficult, even today, to get truly ‘randomized’ trials, much less double-blind, for what should be obvious reasons. Many health professionals already have their own practices and experiences, which suggest to them one or another ‘treatment’ is worthwhile, and so do many patients. Neither professionals nor patients wish to be ‘blinded’ or ‘randomized.’

Hence, regardless of good faith, very difficult to get decent studies of large enough size to generalize. Compounding this is our general impatience – we want results sooner rather than later. For many treatments and procedures, we simply -cannot- know long term effects until … the long term. This means if a drug or other treatment hasn’t been around at least 40-50 years, we simply -cannot- know the full range of effects.

This is why it is generally estimated that LESS THAN HALF of all medical treatments do not have any scientific evidence to back them up.

This is 1 reason why, with different testing standards in Europe, far fewer new drugs get developed & approved than in the US.

This will come as a shock to many here in the US, as evidence-based evaluations are underway in a more meaningful way – I expect many standard treatments to come under criticism, and if we stick to our guns & insist that we not require insurance to pay for undocumented procedures, we will have far fewer treatments done.

The shock will be that – as with many of us – we want health professionals to ‘do something’ to help. The answer much of the time really is ‘we don’t know, in a scientific way, what might or might not help.’ And many of us – patients & professionals – really don’t like that answer. We -want- to ‘do’ something.

And so, we do the best we can with the information then available. Even if some have questioned any particular drug, or treatment, the -fact- is, there is very little science to back up a ‘one-size-fits-all’ approach. Numerous studies suggest that for many people, some drugs and some talk-type therapy is most effective. For some, just drugs are best. For others, just talk-therapy is good. And for some, sad to say, none of the above.

No doubt we all know 1 or more friends or family who have tried numerous drugs, various counselors, etc., and nothing has seemed to work. This is true in physical medicine as well.

Hence, in a very real sense, actually -no one- can know, for sure, whether or not any particular approach, medical or otherwise, might or might not work.

From a scientific viewpoint, we are all guinea pigs for any particular approach, with a sample size of 1.

That is why there should be a dialogue between doctor and “patient” and the” patient” should have the ultimate say in what is going to happen to him/her. There should be trust and openness and not condescension, half-truths or downright lies as it so often happens. Maybe these things should also be taught in medical school.

Arta,
Once upon a time back in the olden days these were taught in school. Interviewing classes with clinicians demonstrating with real volunteer patients. Observed and critiqued interviews and examinations of real live patients.Perhaps they still are. I haven’t been there in a long time.
Any younger docs out there to respond? I graduated in 1983. This was a big part of clinical training.
Alice

Mark,
Thanks for taking the time to compose such a thoughtful and complex commentary. This is a good summry of the complex web of pressures and information we are all expected to navigate, especially those of us in medicine. Most doctors I know do want to help.

I have explained over and over to patients next to me in the office that, indeed, we are doing an experiment of “1”. Everything is not known. Much of what is believed could be disproven. These are theories, not facts. Most have been relieved. Some have been aghast.

This is not the sole territory of psychiatry, the unknown. All is not known.

There are also different standards of marketing pharmaceutical products in Europe as well as differnt standards for drug approval.

However, as a young psychiatrist, I would take issue with one statement: “When you talk to a psychiatrist, remember that the high-end drills have been there ahead of you. There may be no hole through his bucket for your shape and size of message.”

This may be true for many psychiatrists (or, to Stephen Boren’s point, to most doctors of any specialty), but NOT for those of us who are just starting our careers. We, for the most part, have not been corrupted by drug-company money (although our teachers have, to be sure). We’re also, in general, idealistic enough to try to do the right thing by our patients. We’re also closer to our college stats & psychology coursework to know unreliable diagnoses when we see them!

The problem is, psychiatric specialty education is a funnel or blender (or maybe a woodchipper is a better metaphor?) which takes brilliant, engaged minds and processes them into bland automatons on the other end. And our job prospects bear that out: most jobs just want us to prescribe, while keeping people dependent on us and our system.

[In the interest of full disclosure, I’m searching for psych jobs right now so I see the employment landscape first-hand. Also, I’m on my way home from the annual APA conference, where I’ve unfortunately been surrounded by bucketheads all week.]

Unfortunatly I have seen no employer in decades that want more than a fast note and a quick prescription. Many of those jobs are going to lower priced NPs, PAs and (in 2 states and the military) psychologists. Interchangeable prescribing cogs is the deal in most medical systems. I have done my best to sneak in a bit of therapy between the closely counted “prescriber” minutes. I had a therapy based private practice for many years. You may have to make your own way if you want the practice of psychiatry to allow you to be more than a “prescriber”. There are also hourly contract jobs doing disability evaluations out there.

If you’ve been immune to the forces of marketing, you’re lucky. They must not allow drug reps and samples into the training program you’ve been at. Some do not. And those teachers must not have passed on what they “know”. And I imagine the APA no longer takes money from pharmceutical companies to fund presentations. I’m glad your bucket has remained unscathed. My has not.

Thanks for reading and commenting here. I’m glad to know that you’re reading outside the box. Welcome to MIA.

Alice, I’m very disappointed in your post and your rationalizations about the responsibility of individual psychiatrists.

There are only a few dozen drugs in the psychiatrist’s armamentum. Most psychiatrists have their favorites and prescribe the same few drugs day in and day out, all day long. The least they could do is be knowledgeable about them.

Adverse effects of the drugs are described in the package insert, in the PDR, on countless Web sites, and in FDA bulletins. There’s no excuse for specialists not to know about them.

Psychiatrists, particularly those who call themselves psychopharmacologists, tend to be quite arrogant about their expertise in medication. Yes, I am generalizing. It’s a rare psychiatrist who admits we really don’t know much about these drugs and what they do. It’s a rare psychiatrist who admits he or she has harmed a patient.

“There may be no hole through his bucket for your shape and size of message” — you mean no shape for a patient’s report of an adverse effect? Must be that doctor never expected to talk to a patient.

It’s the psychiatrist’s business to know about the adverse effects of the drugs that are his or her bread and butter. Yet something other than patient safety has been made more important to the psychiatrist. Perhaps you can consider what that might be.

Personally, I am unmoved by the argument that psychiatrists have their heads in buckets like everyone else. They are not like everyone else. Psychiatric training is supposed to enhance cognition regarding human behavior. Given this enhanced understanding, psychiatrists presume to not only pass judgment on the emotional, behavioral, and moral fitness of others but to remodel their brains by any means necessary.

Oh, psychiatrists have their heads up very special buckets, all right.

A few years ago, I wrote (for my own enjoyment) a “Patient’s Bill of Rights,” one item of which was a statement that each patient deserves to know the precise (or presumed) mechanism by which each drug will help his/her condition. I never used it or distributed it because it seemed sort of pretentious– like “I know how these meds work and other docs don’t”– but I’ve come to realize that if we doctors actually stop to THINK about what we’re doing and why, the practice of psychiatry might look very, very different.

Dr. Steve, even if patients knew the precise mechamisms how drugs work (and we don’t know those), it still would not answer why someone is distressed/impaired (mechanisms of psychopathology). Giving mechanisms of action for drugs to patients that imply unsubstantiated etiologies of pathologies is misleading. Also, as you say, it makes doctors seem pretentious in that they act is if they know what is actually hapenning (without doing any tests to confirm drugs or psychosocial interventions are “fixing” or changing “diseased” neurobiochemical mechanisms).

If anything, doctors can only inform people (and themselves) of outcome literature: the likelihood and extent that an intervention will provide relief/help beyond placebo, and a description, likelihood, and extent of known risks, and disclosure that many risks are not yet known. Focus on pathoetiology and mechanisms of treatment are at this point unfortunately primitive and underdeveloped at best and downright fictitious and misleading at worst. A big, honest “I don’t know” related to these issues would be welcome by many until you know more. Until then, stick to the limits of knowledge that you have, outcome data of a range of quality from which to discern value of treatments beyond risk.

This is what I was told, about drugs as well as ECT, “We don’t know how it works, we just know that it DOES work for many people.”
They went on to say, “otherwise you’re a hopeless case and you’ll never amount to anything.”

Akathisia, the TORTURE side effect was dismissed with equal aplomb. I might as well have been an annoying gnat.

And like I said in another post about TD, don’t worry, the benefits outweigh the risk.

That line is also used in regard to other drugs, such as all the current fads of cholesterol lowering drugs, HRT until about six years ago, cox2 inhibitors, the list goes on and on, until the patent runs out and the lawsuits are settled.

Well said! I am still too wounded and angry from 15 years of harmful psychiatric care to engage psychiatrists directly but I am hoping to heal enough to do so. In the meantime I am grateful to you for putting so many of my reactions to Alice’s piece into words.

AltoStrata, I have your read your commentary and visited your site and I would like to thank you for the daily efforts you make in educating and assisting those of us who are struggling through the nightmare that is SSRI withdrawal.

Speaking as someone who is now on her third attempt in six years to free body and soul from the debilitating effects of these poison pills (without wreaking further havoc on my professional and personal life), I completely empathize with the impatience and frustration that you feel for those in the medical profession who profess ignorance around the effects of these medications.

In the past year I was lucky enough to finally find an M.D. who recognized that I should have never been “medicated” in response to normal feelings of depression that resulted from a traumatic life event and who has been and continues to be very kind and and supportive in assisting me through the titration process (now down to 36.7 at the rate of 0.05 mg. a day–yippee!). She told me that despite the fact that anyone who has picked up a newspaper in the past five years would know of the dangers of SSRI “discontinuation syndrome” she is alarmed by the number of doctors in her professional sphere who continue to willfully deny both the side effects of these drugs and the illness that so often results from withdrawal.

Dr. Keys may think that you come at the sorry state of affairs of psychiatry/big pharma with a big stick Altostrata, but we are dealing with a big, ugly problem and sometimes anger/passion/persistence is the impetus needed to push for reform. Most game changing activism and advocacy has grown out of feelings of disgust and disillusionment with broken systems. In any case, I personally don’t view your commentary as angry, simply a logical, rational response to illogical, irrational behavior.

While it may be very difficult for a psychiatrist to come to terms with the fact that his or her profession has greatly contributed to the mental and physical harm of many women, men and children, those feelings of embarrassment or shame or guilt can surely be managed far more easily than the daily debilitating and sometimes life destroying effects experienced by those of us who have erroneously been prescribed psych meds. If we as “patients” can slog through the muck that has been made of our lives and find the strength to start over, I’m hoping that the best of the M.D.’s can step up, remove “the bucket”, and do the same. There are exceptional people in every profession and far better to work towards being an exception than to keep your head in the bucket and maintain the rule.

For a concrete example of game changing real life action, for those psychiatrists who wonder how to begin again and move away from the med model, over half of my doctor’s practice is comprised of patients she helps to get off of medication. She is also studying for additional certification in integrative medicine so that she can better evaluate for nutritional deficiencies that can contribute to poor mental health.

Back to my original point, again, Altostrata, I thank you and I thank Mr. Whitaker for turning on the high beams and shining a light of the road to freedom and recovery. One day at a time, one step at a time.

Yes with the help of a steady hand on the syringe and the support of methylated folate 5-htp and fish oils I’ve found that the 0.05 micro-taper is the least life disrupting of the methods that I’ve tried. Cold turkey and the mega and medium tapers were a train wreck for me and I honestly thought I would never, ever get off of this drug. It’s a slow process and on those days that I feel especially well I reduce by 0.1 but that’s the maximum that my poor receptors can tolerate without bringing on the brain zaps, dizzyness, nausea and huge mood swings. It will take me more than a year to be drug free at this rate but I feel this is my best chance for success and I’m grateful to have found something that works for me. Little by little I feel my health is being restored–no more massive bruises on my arms and legs, no more rashes on my back, my metabolism is slowly returning to normal, I can finally sleep again and I’m starting to feel more like the me I recognize instead of the agitated, hollow shell that I and those close to me came to know as SSRI v.1 zombie person. What a long, strange trip it’s been! One thing I’m certain of at this point, if I can survive the effects of this drug I can survive anything that life throws my way without the assistance of medication.

I’m sure my doctor would be an excellent resource for you. I’d like to phone her first and let her know of your interest in case she gets inundated with calls and wonders where they are coming from. I’ll be in touch soon.

That’s exactly how it is. Our nervous systems become sensitized by these drugs, and can tolerate only incredibly small decreases in dosages. (Right now, I’m tapering Lamictal by .01mg every 4-5 days, and I still feel it.)

Your doctor is brilliant. I would like to correspond with her, if possible. Please give her my regards.

Ruby,
I’m glad you’ve found good help for your efforts of tapering off medicine. All the best.

The “bucket” I referred to in the article is not the exclusive domain of doctors or psychiatrists. We all have our unique belief systems we each call ” the truth”. Fascinating.

My hope is for cooperative healing relationships here that allow people from all disciplines to come together to make mental health into a better and more humane process for all. Everyone wants to feel better and suffer less.

There are times when (understandable) anger makes the conversation less open to anyone from the mental health field. If excluding mental health workers in the point, we should be clear up front. No one comes here to be blasted. I don’t. We should post a warning sign or something.

Thank you for your response to my comment. I can appreciate that no one person or group wants to be scapegoated for the ills of an entire culture that looks to the pharmaceutical industry and its agents for the healing of myriad medical problems. I believe that all of us, doctors and patients alike, have a responsibility to stay informed about the health care options currently available and to make best efforts to make rational decisions.

As a layperson, the only individual in the “system” with whom I had a relationship, interfaced with and trusted to keep me safe was a medical doctor, not a pharm or regulatory rep, not an advertising or P.R. exec, not a senator or congressperson. When that sacred trust was broken and I was left alone to manage my withdrawal the feelings of betrayal that I experienced were very intense. I had genuinely liked my doctor. She was well educated and smart and funny. However, when I wanted to get off of the medication that made me sicker than I had ever been in my life and pointed to the publications that supported my decision, she was also stubborn and defensive and hostile despite the fact that I was the one who was suffering. At that point in my treatment, we were most definitely not in it together. I could have only continued to work with her had I agreed to add an anti-psychotic to my regime to address the agitation that resulted from the SSRI. Of course, I refused. I honestly don’t know what personal beliefs or needs informed her decision making around prescribing. That is not a wall that I could ever break through with her.

Speaking from my own experience I believe that anger is a part of the oftentimes very raw process of mourning lost time, lost opportunities, lost relationships and in the worst cases, lost lives. All of us in the system are at different stages in that process and I think any meeting of the minds will have to allow for the intense emotions that surface from time to time as we struggle and grieve and try to carve out a more human treatment model. Sometimes I can just sit with my feelings and sometimes I must whack a tennis ball really, really hard. On the tennis ball days, I try not to post comments on the internet. Whatever works.

I wanted to add this link to you as a p.s. to my comment. It is a petition site directed at the manufacturer of Effexor notifying them of the side effects of the medication. In my personal opinion, it would more effective to direct the document to the Congress and Senate as I’m fairly certain Wyeth couldn’t be less interested. In any case, my point in sharing this with you is that it provides many examples of what patients can experience in taking and withdrawing from this drug. I’m sure you come across these types of outcomes in your work, but for me it really hit home to see so many lives in turmoil as a result of this one medication. There are similar sites for SSRI’s as well. The new epidemic–iatrogenic illness.

Ruby,
I, too, get angry at the condition of our medical system. I, too, have “fired” doctors for not listening to what I said (six of them over the years to be exact). One would have let me bleed to death from a miscarriage at home rather than take my call.

I once had to remove my child AMA from a pediatric hosptial to save his life from the wrong treatment when he was small. I had to pull his IV out of his arm myself at one in the morning and carry him through the front door on my back to save his life. Turned out later they had the wrong kid’s chart, missed the collapsed lung on his x-ray and held him down to give him the wrong medicine.

This is not all about psychiatry. The medical system is no different for an outspoken, reading, thinking doctor with blue cross insurance than for anyone else. Things have been way broken for a long time.

Internal medicine and primary care has been just as swept away in this pill culture as psychiatry.

All of us have very good reasons for anger. I’m convinced that the only ones our anger serves are those running the profit-driven corporations that have a death-grip on so much of our country. I will not give my thought capacity away to them by falling into rageful bickering, finger-pointing and name calling. There is way too much work to do. The only tools I have are my words.

When I feel too angry to moderate my communications, I go for another brisk walk. Some days are three walk days.

After writing this one, I’ll go for a run and see if I can come back to write later.

I’m very sorry to learn of what you experienced when you and your child were in need of urgent medical care. We are all so vulnerable when we are sick or in pain that it is easy to become paralyzed by fear and allow circumstance to dictate our fate (that almost happened to me when I tried to go cold turkey off of the psych med). How fortunate that you were able to keep a cool head and avoid tragedy. I’m not sure I could have done the same.

It is so true that the tentacles of the pharma industrial complex have penetrated every medical discipline–health care by market share. It never ceases to amaze me how adept manufacturers are at re-purposing drugs to squeeze every last dollar out of any given formulation. Recently, a sports medicine doctor offered me a seizure med to treat a repetitive motion injury from working out. Yes, really! I thought, hmmm I was hoping for some targeted stretches for my hip so I’ll pass on the brain med if it’s all the same to you, doc.

What I’ve learned whilst managing the twists in and turns in the medical maze is that I really need to be my own best advocate. After my life changing experience in SSRI-ville, I focus on educating myself to maintain my health which has greatly increased the options available to me before I need to turn to any medication whether it be an NSAID or a cold med. At the end of the day, I have the most to lose. Not to mention that chipping away at the feelings of anger, hurt and fear and replacing them with self-sufficiency and empowerment is a good all around life enhancing project.

BTW, you may be interested in a book that I used as a guide for supporting my tapering process through supplementation. It is titled The Breakthrough Depression Solution: A Personalized 9-step Method for Beating the Physical Causes of Your Depression by Dr. James Greenblatt. Dr. Greenblatt is a child and adult psychiatrist Waltham MA who specializes in integrative medicine. He seems like a good guy.

I agree we filter our thoughts and feelings through our experiences, and none of us is unbiased. I also agree that we are all human, and it hurts us all when any individual or group is treated as “other” – as you say, we have more in common than not in common.

But there are important differences between psychiatry and others in “mental health” – in who did the drilling in their buckets, where they chose to drill, and what’s needed to change psychiatry’s buckets. Not facing these differences will defeat any effort to fix the drug problem.

Psychiatrists are the most thoroughly indoctrinated in PhARMA’s and bio-psychiatry’s myths. It’s virtually impossible to join your profession (or remain in it) without “going along” with the myths of medication. That is not nearly as true of social workers, LCPC’s or PhD psychologists – it is becoming more true these days of us too, but it certainly wasn’t 16 years ago when I got my MSW, and it’s still strongest in psychiatry. Think Loren Mosher, Peter Breggin, Grace Jackson.

For decades, the smartest people in psychiatry have not even been psychiatrists. They have been PhARMA executives and marketing strategists. They have a strangle hold on psychiatry, in subtle and blatant ways saying, “Do it our way or lose your income.” Read Healy’s Pharmageddon, pp. 224 – 228: he was present at a meeting when the Royal College of Psychiatrists considered putting up “firewalls against pharmaceutical influence.” Healy reports this from a PhARMA rep who was there:

“”When it came to issues like our asking for the data from clinical trials, (the most senior figures in British medicine) would not be putting their knighthoods on the line to insist upon access to raw data … Within academic psychiatry alone, he went on, there were twenty-five senior figures in Britain each earning in excess of $200,000 a year out of links with industry… And finally, we clinicians all needed to note that 40 percent of British life insurance policies were invested in the pharmaceutical industry. Whether we liked it or not, we were shareholders in the industry, and rocking the boat would not be in our interest.”

PhARMA has for decades been one of the top two most profitable industries in the world. They have the largest lobbying force in the U.S. – more than one lobbyist for each member of Congress; they pay 40% of the FDA’s drug approval budget; they fund about 80% of all research; they track the prescribing practices of every doctor in the U.S.. They spend $40 billion a year on research, and $60 billion on “promotion.” Their detectives dig up dirt on those who oppose them (at least if they seriously get in PhARMA’s hair); they are ruthless and overwhelming in legal battles (think the Wesbecker case); U.S. psychiatry’s enmeshment with PhARMA make’s England’s look like child’s play (think Martin Keller’s $800,000/year income from PhARMA and Study 329).

In short – Theodore Dreiser (I think) said something like, “It’s hard to get a man (woman too, of course) to understand something when his (her) job depends on his (her) not understanding it.” Psychiatry, far more than other “mental health” professions, is in that position. That needs to be acknowledged before real progress is possible.

I am not a defeatist. I have spent decades as a community organizer and, later, as a guerrilla resister to the excesses of the “mental health system.” I think we first need to change your bucket analogy, which is still in line with bio-psychiatry’s fatalistic orientation. It seems to assume we start out dense and our learning largely depends on others drilling holes in toward us.

We are eminently social beings, and other people are key to our development. But I see the bucket another way: We are born with minds wonderfully open to all kinds of information and feelings, eager and able to learn and grow. It is our exposure to the pain, anger and limitations of the adult world that begins to construct the bucket. Adults do build bridges to us too, but they also force us to shut down large areas of our understanding in order to survive in the world they inherited and constructed.

The struggling adults around us started out like we did. But they inherited the struggle of our species – the only species that came into this world really physically unfit to survive on instinct alone, and needing to develop our intelligence to flourish. That is a huge task – just think – in all human history, it’s only been 130 years since we learned bacteria cause infection; the average life span in ancient Greece was just 35 years. Now, in some parts of the world, large numbers of us are born into physical and cultural environments where the fine tuning our minds crave and need is a realistic possibility.

We come by our painful inheritance honestly. The trick is to focus on the amazing resilience, intelligence, cooperation and love that humans inherently possess to have survived and flourished as we have. We still carry tremendous scars, but we have a wonderful future if we will take it.

We need to regard each other as inherently reachable, inherently eager to make connections and broaden our understanding. The great “organizers” of history have, against great odds, continued to believe how good we all are, and have powerfully communicated that to large numbers of people. They assumed that inside each bucket was someone eager to drill their way out to meet us – their assumption was the best “drill,” and it encouraged others to drill out as fast as they could too. That is, they inspired people. Mandella, Ghandi, Martin Luther King, Roosevelt, Churchill.

It is great that individual psychiatrists are thinking and speaking, as you are; and it’s happening more and more. But it will take a movement and real sacrifice, over many years, to fundamentally change what is wrong with the paradigm that allows and encourages the abuses we see now in psychiatry.

Alice’s “Call Me ‘The Doctor'” versus “My ‘Head in a Bucket'” — as good an illustration of cognitive dissonance as any. Both can’t be true at once.

Correct, we’re all chimpanzees dressed up in suits. Psychiatrists undeniably share human biology with the rest of humanity.

Yes, propaganda is persuasive. That’s what it’s designed to do.

Pharma made fools of psychiatrists, but not everyone was gulled, as Peter C. Dwyer noted above. Giovanni Fava published “Long-term treatment with antidepressant drugs: the spectacular achievements of propaganda” in 2002.

The ethics of the Good German argument etc. have all been hashed out. “I was blinded by advertising” — well, that’s not gonna fly.

You either get to be a scientist of the mind or a dupe. If you’re a dupe, you’re not the expert you thought you were. If you’re The Doctor, you’re stuck with that guilt-inducing responsibility. Which is it?

Altostrata,
I’m a marketing dupe. We’re all marketing dupes. This is the point of “Bucket”article. Thanks for getting it.

Are you German? I’m not. My extraction is Portugese, Italian, Irish, Dutch etc. Excuse me. Maybe I mistake your “good German” comment. Are we back to the Nazi rhetoric again? There is no place for bigotry and target practice of any kind in an open, solution-focused discussion.

The widespread philosophical discussion of personal responsibility following the Nazi era set the gold standard for ethical behavior in socially volatile situations.

Festinger published A Theory of Cognitive Dissonance in 1957, discussing how people can both know and not know some unpleasant truth at the same time.

The elevation of some aspect of self-interest can motivate people to discard evidence right in front of their eyes, even if such denial is ultimately not to their benefit.

This is true of those who make bad bets on stocks but refuse to take a loss because they think they’re stock-picking geniuses. It’s true of people who can’t see their spouse is cheating on them. And it’s true among psychiatrists knew they were being played but chose to ignore it.

The central question in cognitive dissonance is: What was in it for me?

As a brilliant commenter said up above, the marketing folks are the real engineers of the human mind. What was it pharma very calculatingly offered to psychiatrists that made them blind to reality?

I don’t think it was merely money and employment. My theory is that the drugs offer psychiatrists a much bigger prize: Power without responsibility.

You can think of yourself as a hero as long as you ignore risk to your patients.

That is how, on a very personal level, a psychiatrist who is otherwise a nice person can see adverse effects but not recognize them.

It must be very hard for a doctor to let go of a heroic self-image and admit he or she has harmed patients.

Altostrata – Your bigotry against psychiatrists, especially those who have seen the light and changed how they practice, is tiresome. What’s your point here? If you want to snipe at psychiatrists, why don’t you point it at someone who is actively supporting the pharmaceutical model? Alice’s posts have been thought-provoking. I suggest if you’re really going to be on the boat, to try paddling rather than whacking people with your oar.

I hope we can all find ways to remember to work politely together. I hope not to take shots at anyone, even if they do support a “pharmaceautical model”. Being on the attack creates more hostilites and a closes the doors of communication. I believe a peacful, understanding and cooperative approach is necessary if we hope to have a real impact on changing things.

On day one of a psychiatric rotation in med school, future shrinks see innocent people who have been denied any due process, detained without trail, who are subject to vicious forced drugging assaults. The future shrinks accept that this is moral and right, and peep in to these people’s confidential medical files without consent, treat the detained persons as learning tools against their will, and accept that this person should be tortured just for the thought crime of believing they ARE Jesus rather than believing IN Jesus.

You do have a good point there. Despite my optimism regarding young psychiatrists (in my comment above), I must confess that in my last place of employment, the first-year trainees learned more about how to argue (and win) a due-process hearing, and how to write a reimbursement-worthy note, than how to communicate effectively, empathically, and compassionately with a patient. That skill was possessed by some, and not by others, but it sure wasn’t taught, encouraged, or valued.

The point is that psychiatry forcibly tranquilizes the person accused of being brain diseased, BEFORE any due process hearing, (during the hold). The point is further, that this is just one of the many ways in which it is never a fair fight in any so called hearing.

I’d further add that unless a human being is willing to stand up for the accused’s right not be defined as a ‘patient’ then clearly the message of human rights is not getting through.

“the first-year trainees learned more about how to argue (and win) a due-process hearing, and how to write a reimbursement-worthy note, than how to communicate effectively, empathically, and compassionately with a patient.”

If I’m ever caged and labeled by one of your first year trainees, I won’t be interested in them ‘communicating effectively or with empathy’ with me. It will be meaningless in light of their human rights abuses.

If you cage someone on the basis of their non-criminal behavior and thoughts, and if you forcibly drug someone’s brain on your faith based belief that they are brain diseased diseased, you’re a human rights abuser. Period.

The first and foremost communication we would like psychiatry to hear from survivors is that when we say NO, we mean it.

There must come a dawn in society where citizens are free to choose whether to entangle their lives with the pseudoscience that is psychiatry or not, much like we can take or leave chiropractic.

Coercion is unreformable, unconscionable, and completely evil.

You spoke on your blog Steve Balt of ” the extreme animosity from the anti-psychiatry crowd”.

You need to seriously come to understand the difference between anti coerced psychiatry, and anti psychiatry. To be anti abortion is to want abortion to be illegal. I don’t want psychiatry to be illegal. I want psychiatry being forced on people to be illegal.

I just want to feel safe from you and your profession Steve. If you have the power to coerce me, I don’t feel safe.

I really do love how you call a paltry hearing you have no option but to turn up to in a forcibly tranquilized state, after a couple of days of enduring forced drugging assaults and being denied phonecalls, a “due process hearing”.

I’m pretty sure the founding fathers didn’t have such a monstrosity in mind when they set about framing the constitution.

What do you call an adversarial legal situation where the party in legal jeopardy trying to plead for their freedom has already had their very thinking organ assaulted by the party fighting to take away their freedom?

A kangaroo court ‘hearing’ where the dominated party already has forced neuroleptics coursing through their veins.

Everybody should be aware that psychiatrist Steve Balt, made a blog post last year where he approving linked to E. Fuller Torrey’s pro forced drugging propaganda, so we can assume he is in favor of forced drugging community commitment.

“Psychiatry should not be a tool for social justice. (We’ve tried that before. It failed.) Using psychiatric labels to help patients obtain taxpayers’ money, unless absolutely necessary and legitimate, is wasteful and dishonest. More importantly, it harms the very souls we have pledged an oath to protect.”

He linked to (Forced) Treatment Advocacy Center propaganda material when he said the words “unless absolutely necessary and legitimate”.

All readers of these blog comments should be aware that psychiatrist Steve Balt considers the threats to your liberty to be found at E. Fuller Torrey’s pro forced drugging “policy” page.

Anonymous–thanks for bringing up the horrific agenda promoting Fuller Torrey and the website that promotes drugging of patients, forced drugging and forced OUT patient drugging ran by TAC. Torrey is a dangerous influence touted as an “expert”; he is behind a propaganda machine that sounds as if they “care” but in fact they promote articles that depict violence in “mentally ill”.

Here is an article that explains what Fuller Torrey is all about and it is not to benefit patients!

“As president of TAC, and executive director of Stanley Research, Torrey is a man with a mission: to force people with schizophrenia and manic-depressive illness into involuntary treatment. Once considered the patron saint of the family advocacy movement, his clamor for involuntary outpatient treatment in the last five years has dimmed his leadership and threatened the coherence of the movement he helped shape (Mental Health Weekly, 2/19/01).

Torrey explains his obsession with forcing people into treatment–it even crept into testimony about homelessness before the House Committee on Banking and Financial Services (3/5/97)–by discussing a unique category of “untreated” people with schizophrenia and bi-polar disorders, a category he created that remains unrecognized in both government and academic research. These folks, he says, are responsible for 20 murders a week, 1,000 a year.”

Anyone IMO who promotes Torrey and his sidekick Jaffe are not pro-patient.

My guess is that all participants on this webzine want forced drugging to disappear from our society, including Steve Balt. That is our common ground and why we are talking to each other.

There are differences of opinion on how this can be accomplished, and on whether this can happen quickly, or whether it will take some time, and on whether there is a viable alternative right now to replace forced drugging.

Right now, people are thinking about alternatives to forced drugging. Forced drugging is sometimes abused, but its original rational is to be used for people who are cognitively impaired to the point they don’t recognize the authority and role of law enforcement, or don’t recognize that the presumption of innocence does not mean their liberties cannot be temporarily restricted, or don’t recognize that law enforcement mistakes (or misinterpretation about probable cause) can only be pointed calmly, and usually only arbitrated later in front of a judge, rather than by trying to physically oppose law enforcement orders.

Those cognitive impairments used to be answered by physical force from law enforcement, and forced drugging was considered a more humane method. Now people are coming with solutions based on people trained to be emphatic, calm, and calming even in the presence of extreme emotions. When those empathic skills are not sufficiently present to calm down such an out-of-control situation, what is law enforcement supposed to do?

I think forced drugging will be better fought by understanding why it exists and proposing alternatives (and fighting in courts its abusive usages), rather than by just wishing it away, or condemning all possible usage.

Forced drugging is what happens when people are discharged from psych hospitals every single day. Some have court-ordered medication compliance adherence written into their discharge plan. I think people may not understand that no one discharges from psych hospitals OFF of medications.

The phrase “forced drugging” can sound complex, but in fact it is actually status quo for hosp discharge.

Any instance of a psychiatric drug going into somebody’s body by physical force, or by threat of taking somebody out of their home or off the street to a place where it is legal to use physical force (orders to take drugs), counts as forced drugging.

Stephany,
Being a psychiatrist, I risk another volley of cannon fire but here is the truth from 8 years of experience from 2004-2011. This is not a stance for or against “forced drugging”. It is simply a report from recent experience at work. I hope it’s useful information.

I have worked in a crisis clinic for the uninsured that handles (among many other things) temporary medicine continuation post-hospital discharge. These people were not “mandatory” or “forced” to take drugs even if they had been on an involuntary committment at the hospital. There were “no court ordered medication compliance” in their discharge plans. These people came on their own and asked for the medicines. The people I occasionally met with court mandated drugs were involved in the criminal justice system, not the medical system. The medicines were part of a release from incarceration ordered by a judge. They also walked in.

I contend that, at least in my city, forced drugging is NOT “status quo for hospital discharge” at you say.
Alice

I’ve been inside 4 in WA state and they all d/c with medication plans, many are court-ordered where the patient has a 90 day window of time to comply “or else” and the “or else” part is if they stop taking their meds, the case managers et al can testify in mental health court against them, using that to re-admit them. I’ve had to sit in mental health court for over a decade and have heard a lot over the years. This is also where I knew I would always sit on the other side of the room from NAMI parents who would sit in court and complain their adult children were off meds and they wanted them locked up…and while sitting in the waiting area, parents were always shocked when their adult child’s attorney would come out and tell them their child refuses to see them. Because the parents were their to testify against their child.

My adult child is no longer part of that–and when she was, I went to court to testify on her behalf, as HER voice and state she would not want to be there, and I did this, so she would not have to endure the court scene which is undignified, and usually if not always in favor of the prosecuting team (the doctor/hospital). At times, this was a grueling experience, and where I saw many people w mental health labels suffering for many reasons, and they always got sent back to “lock up” (plea for discharge denied).

Who can ever imagine this exists? many people have no idea this goes on.

Even in places where people are not forced to take med’s by court order, more often than not it is a requirement to get any other services. If you don’t take med’s, you don’t get housing, if you don’t take med’s you don’t get any psychological treatment. And of course even if they are not forced, when it is very largely the only thing on offer what choice do they have. It is either take the med’s or have no treatment at all, as no other treatment is offered. I have NEVER met a person who didn’t want help, I have also never met a person who wanted the help they were recieving. But you learn, you either take what they give or you go without. Hardly an informed choice.

Maree,
Of course, there are other ways to enforce without a court order. Parents are forced to drug their children to access both public and private schools.

True statement you make “… you either take what they give or you go without.”

As you say, “(medication) is very largely the only thing on offer what choice do they have.” Drugs are the only thing many clinic have left to offer. Funding for every other service has been methodically cut from above, even before the recent economic down turn.

I know a child on ritalin. I expressed doubt as to the benefit of it (he was still a hyperactive pain to most of the teachers but was fine with the teachers he liked, I could go on giving a psyco-social explanation of his behaviour but you get the picture – i was the lowly teaching assistant). His head of year said he would not be allowed in the school if he did not take the drugs.

That is a kind of force, not an absolute legal sanction but still quite a sanction.

I know a mother of someone diagnosed with schizophrenia who had a nurse phone her up in the evening to check whether her son had taken his meds and pressuring the mother to take the son to go to the late night chemist to get some.

John,
I had a conversation with a friend this weekend about a child that must take stimulants to be allowed in school. This is routinely done in this country both in private and public schools. When a family depends on school to provide day care for a child so they can go to work, they are in a real bind. Staying home means job loss. What can the parent(s) do?

Since many of the children’s drugs come through pediatrician’s offices on the recommendation of educators, where can this be stopped?

Exactly. I don’t know where Alice lives but it sounds like some kind of nice fantasy land. People are discharged from the hospital where I work with forced drugging in place. If they don’t comply they can lose what little they have, which isn’t much in the first place.

Stephen,
I live in a different state that Dr. Keys. I have never been “forcibly drugged”, and all but the first of my experiences in the psych machine were voluntary.

However, when I was in pain, psychological, physical, spiritual, and sought help from “professionals”, once I signed myself in, I was stuck in a place where pharmaceuticals have replaced straight jackets, and treated as if I was not only crazy but stupid, for a minimum of three days.

Once you sign in you can’t sign out. I called 911 from the unit phone, which they all got a laugh from, although they took away my phone privileges. I survived, and now I look back and laugh too.

The “forced drugging” for me was the cycle of being on meds, trying to get off of them and then going into REBOUND, which to the professionals is RELAPSE. I believe they honestly didn’t know the difference.

As for the “how could I have known?” we all bought it, it was the big “breakthrough” and it was held out as HOPE.
I held onto that HOPE, ignored the red flags, ignored my intuition, went along with it because it was ubiquitous, and still is.

It is a culture, all the way from the streets to the psych units– we want a quick fix for problems for which there is no fix, and I have searched for someone in my state who could help me get off benzos. There are no alternatives around here, never have been. And my scarlet letter follows me, too.

They were still Freudian when I was first hospitalized, right on the cusp of the transition to all-drug and ECT treatment.

As for my current attempt to get off of benzos, I am doing it ALONE. I have support from benzobuddies, and have to remind myself how far I have come from Paxil, Thorazine, Depakote, Clozaril and on and on.

My PCP writes the Rx’s and doesn’t question why the dosage is going down. (She’s “compliant”.) She also doesn’t care, which is fine with me.

Considering the attacks on Dr Keys, I hope she continues to be as caring and responsive as she has been so far. I wish I could shout, “She’s on our side, guys! She’s listening!”

Other shrinks*, even here on MIA, have been more defensive and simply move the conversation into safer territory.

Thanks to Robert Whitaker, we are all on the edge of a TRUE “breakthrough”. It won’t be simple, it won’t be easy, but (I) thank God, it is happening.

*funny how we now know our brains were literally being shrunk. Like I said, Ya gotta laugh.

I find this slightly distasteful. I know someone who is on a community treatment order and forced to have depot injections, which she does not want and objects to on health and human rights reasons. She is on the CTO because she was found in her house, not eating a lot, looking a bit scruffy and not going out much.

She kicked a psychiatrist once (now don’t all cheer), it was several years ago and because the psychiatrist put her on depot injections. This is now on her notes and taken out of context. She is not a danger to herself or others, when at her most distressed she needed someone to sit down with her and have a cup of tea and a chat (ok, maybe she needed that everyday for a week or two, but you get the picture), not years of injectable major tranquilisors.

There are people who worked with people who were angry, violent and disruptive who did not use drugs. They have a track record of success.

One I know worked with murderers in a therapeutic unit in a prison. Drugs were used, but by consent. When he started loads of drugs were used, after he got going hardly any were used. People on the unit were treated with dignity and respect, as far as this is possible within the confines of a prison.

As far as I can see the evidence that these drugs, either forced or not, reduce violence is lacking. Without that we are looking at a medical system that tries to control people with drugs based on custom and history rather than evidence or any real concern about public safety

Let me say that I found some content on the mentalillnesspolicy.org website disturbing too (I should have read it more before my first reply). And I happen to disagree with most mental illness conceptions from E. Fuller Torrey. I strongly believe in the recovery concept (which implies I believe in at least some conception of mental illness).

In fact I probably went out of subject. I admit I was seriously disturbed by the claim that Dr. Steve Balt is not pro-patient. My view is that this claim is difficult to maintain if you take the time to read his blogs (I personally don’t consider that linking to a website is equivalent to endorsing all its contents).

I read your link and concluded that Torrey is dangerous. He’s Kevorkian-like in his ghoulish brain collecting, and just as much of a sociopath.

My doctor’s office has a new form stating that any blood, fluids, body parts, tissues etc that are removed in the course of a procedure are no longer the “property” of the patient, but belong to the hospital or clinic.

“To be sure, there are cases in which a person’s suffering is so profound, and so obviously rooted in physiological dysfunction, that aggressive measures must be taken to treat the disorder.”

If it’s so ‘obvious’ Steve, how about you show us some evidence of physiological dysfunction. Also Steve, I think by you linking to E. Fuller Torrey’s propaganda that you mean the ‘aggressive measures’ to be forced drugging? am I correct?

The problem with psychiatry is people who think ‘so obviously’ is enough to stand in for actual evidence.

DJ Jaffe, Torrey’s full time propagandist has left many positive comments on Steve Balt’s blog. It seems Steve Balt is DJ Jaffe’s kind of psychiatrist.

DJ of course is this guy…

“Others at TAC have acknowledged that the focus on the violence of the mentally ill is in part a cynical ploy to encourage funding for treatment. “People care about public safety,” TAC publicist D.J. Jaffee told a workshop at the 1999 meetings of NAMI. “Once you understand that, it means that you have to take the debate out of the mental health arena and put it in the criminal justice/public safety arena.” He had earlier advised a local New York advocacy group (SIAMI Newsletter, Vol. 9/12, 1994), “It may be necessary to capitalize on the fear of violence.”

Here is part of Fuller Torrey’s Op-Ed that ran in The New York Post regarding Kendra’s Law:

“Kendra’s Law is proving to be what its authors designed it to be: A safety net protecting the severely mentally ill and the communities in which they live.

While they have yet to fully embrace the promise Kendra’s Law brings to the state’s most vulnerable, we hope these well-intentioned yet misguided civil libertarians eventually recognize that defending an individual’s right to remain psychotic is mindless.”

That’s who Fuller Torrey is, he is someone who believes schizophrenia is an airborne toxin that we all are subject to breathing in, and he said when I heard him speak in person that we are ALL exposed and some “get sz and some don’t”. He equated bipolar and SZ as being the same thing, and he called the antipsychotic Haldol an “anti-viral” and when I asked him how he could call Haldol an anti-viral? he said he did not know. Though from that POV, one can deduct that a virus born “illness” can be treated with an anti-viral…Schizophrenia and Haldol. The man gave me the creeps.

Thank you Stephany. It speaks volumes that Steve Balt has DJ Jaffe dropping by to complement his blog and leave comments, and that Steve Balt is linking to (forced drugging lobby group) “Treatment Advocacy Center” websites.

Unlike Stanley Holmes (above) ” fighting in courts its abusive usages”, I believe forced drugging in and of itself is an abuse, a human rights abuse furthermore, and I believe that simply by virtue of all humans being human, they are entitled to human rights.

There is no picking and choosing the instances in which a human rights abuse is justified. Each and every person who has been assaulted with forced drugging, had their human rights abused. Each and every person has the right to not be assaulted, and each and every person has the right to decide what happens to their own body, not to have their body turned into an object to be altered by force by mindless biological psychiatry fanatics.

One of the things that most people don’t realize is that it’s not just psychaitrists who are killing people with their toxic drugs. Thousands of people will die this year from meds prescribed by doctors of all kinds. The FDA is not doing it’s jub to protect us from bad drugs and doctors are not researching enough, and Americans flock into doctors’ offices every day, demanding some pill to take care of their woes, aches, and pains. I’m not absolving doctors of any specialty from responsibility, but the real and true culprit is Big Pharma. It controls the media, it controls the education of psychiatrists, it controls the APA, it controls the scienfitic journals were studies don’t get published unless they agree with “shove more meds down peoples’ throats,” it controls the polliticians making the laws used against us. The real question is not how we stop the psychiatrist from drugging us, but how do we got real power over the drug companies which are totally out of control at this point. Many psychiatrists need to be “defrocked” and sent off to find other kinds of employment, there is not doubt about this. But if there was some control over the drug companies these damned toxic drugs wouldn’t be handed out to psychiatrists in the first place and they’d have to make an honest living of having to really and truly listen to their patients, instead of dismissing us as “having no insight into our illness.”

I haven’t read all of the above posts, so I’m not sure if anyone else mentioned this, but there certainly were publications that detailed the inadequacies and inaccuracies of bio-chemical etiological theories of psychosis and of evidence on the usefulness of medications since at least the 1960’s. Some of this information was in Bob’s book. Particularly, Bert Karon’s book Psychotherapy of Schizophrenia: The Treatment of Choice, which came out in 1981, included a substantial discussion of these topics. I say this not to point fingers or to lay blame, only to make the case that this data was out there for psychiatrists to examine and that many chose not to do so. The casting out of psychoanalysis from medical psychiatry, which began during the 1980’s, likely has much to do with the tendency of psychiatrists to ignore or view with disdain much of this material. The simultaneous rise of pharmaceutical influence on the discipline of course played a huge role, as well. Nevertheless this contrary evidence has been there all along, seemingly of more interest to many of those caught up in the mental health system than to many of those tasked with running it.

Greg,
“Caught up in the mental health system” certainly describes my experience from the time I set foot outside the halls of my training programs. I don’t recall being in charge of anything beyond my small psychotherapy (no cash flow) private practice and the prescription pad I was allowed at the hourly pay/no benefits jobs. I had a LOT of high interest medical school loans to pay.
Thanks for your post.
Best,
Alice

I hear you on the crushing effect that grad school loans can have. While I’m currently finishing my doctoral program and therefore am not required to begin loan repayment just yet, once I’m done my wife and I will have a combined liability of around 250,000$. That will certainly have an effect on the professional decisions that I make, much as they seemed to have an influence on yours.

However, this regrettable economic predicament is not relevant to my earlier comment, at least as far as I can tell. What I was getting at is that there has been an abundance of information regarding the holes in biochemical theories of ‘mental illness’ and lack of efficacy/harmful properties of psychotropics for at least a half century, and that psychiatrists have largely either ignored or actively worked to discredit this data. With all due respect, I am not sure how one’s financial obligations might logically serve as an explanation as to why a clinician did not pay attention to these materials. Regardless of whether we are forced to work in an environment that we might not enjoy, or do not make sufficient monies in these positions, I believe that we are responsible for seeking out information outside of what we are taught within our training programs to make certain that we’re as knowledgeable as possible with respect to the tools of our trade, the theories serving as their foundations, and the actual efficacy of interventions.

Additionally, when I spoke in my first post of “those who run the mental health system” I did not mean that you were some bigwig with an administrative position. I was referring to your role as a practitioner who has power over the lives of those men and women who come to seek your guidance and assistance. I was making the point that it seems to me more people who were being treated for mental health concerns were aware of critical information regarding mainstream treatment than were those tasked with providing it.

Again, I do not say any of this to offend or accuse; I myself have, many times in my life, been ignorant as to alternative views on topics for which an adoption of accepted wisdom, albeit incorrect wisdom, was the norm. However I would be disingenuous if I did not accept responsibility for my role in not seeking out this information. You’ve mentioned advertising in your posts before, a subject that I have been studying for quite some time along with the related field of public relations. Much of what I’ve learned about these disciplines runs directly contrary to what I was taught before I took the responsibility to find out for myself what kind of a world I live in, and what the ‘truths’ are in terms of how I’m spoken to by commercial and political institutions. It was my responsibility to seek out this information so as to become a sufficiently informed citizen of this nation, just as I believe it is the responsibility of all clinicians who work with human beings to seek out truths about medications and neurochemistry if they are to be informed citizens of the ‘psychiatric nation’, so to speak.

I have the utmost respect for you and what you’ve been writing on this site. You seem to me to be a caring and passionate person who really wants to do the best that you can to help those with which you work. I guess I’m mainly just wondering why you seem to have some difficulty with saying just what I have said above; namely, that you did not search out the information of which I, and others on this site, speak, but now that you have been alerted to it you’ve become determined to do something about it.

There was not “an abundance of information” for “half a century” in any place that I could find in public libraries, medical school libraries, professional books or journals. Sorry. The information, in those pre-internet days, was not findable even by a well-meaning, well-read professional like me. Even now, the internet is a wasteland of mis-information. It may be even harder to sort anything out.

When I figured out (by attending classes, reading and pondering) that there were some holes in the theories (as early as the early ninties) I did begin informing my patients of this and talking to people around me. I changed how I practiced. I think that’s as good as one can do. I expect there are many who did likewise.

Monday morning is a great time to re-play the game for the quarterback and find him lacking. It looks much easier after the fact.

For me to say that I didn’t look, ask, search and read to the best of my ability at the time, would be a lie. This is why I don’t say it. It’s not “hard to say”. It comes across in the commentary section here like people want me to make a forced confession of wrong doing. What goal would be furthered by this?

If me taking personal blame and being scapegoated for many things that were clearly beyond my control(ex. hidden information, marketing disguised as education) or taking the blame for not knowing things that only became widely known at a much later date would help us move forward on the re-make of our system, I could do this. Perhaps

Except it won’t move us forward. It will only serve to further the anti-psychiatry bigotry that is no prettier than anti-patient bigotry. It will become the required hazing process for anyone that presents wanting to help.

We can’t afford to chase away mental health workers who may be able and willing to help witt the remaking of mental health. Some of them may have good ideas.

Best,
Alice

PS My student loans didn’t force me not to find information. It only enforced work choices. You will be there any day now. (My loans acrued compound interest while I was in school at 18-22 percent. Doctor loans for those rich doctor-types.) You loans will force your work choices for decades. This is a long time. Sorry.

Thanks for your reply. As for Monday morning quarterbacking and anti-psychiatry bias, I don’t feel that I’m trying to engage in either. I wasn’t in your shoes so I can’t say anything about your experiences and your process, and to be “anti” psychiatry is a foolish notion in my eyes, as well. What upsets me is when many psychiatrists and medically minded psychologists with which I have spoken who have recently become aware of critical appraisals of their disciplines, including you, repeatedly make the claim that they were powerless in the face of advertising and institutionally perpetuated conventional wisdom, and that it is ridiculous for one to assert that they “should have known” about alternative conceptualizations. My response to this line of thinking is that over the years there have been many practitioners who did know, who made it their business to find things out for themselves, and who accepted responsibility for their lack of knowledge in instances where they had been bamboozled.

This is not to say that you should be forced to admit something that you feel is untrue, or to admit anything at all, really. I am not writing all of this to “win” anything by shaming another person into making admissions of culpability. But I do feel that all of us who have gone against the grain with respect to our beliefs on mental illness and medication, and have paid for it in numerous ways (even me, and I’m still just a student), have a hard time when someone tells us that they couldn’t possibly have learned the things that we have learned. I myself was not in the field until recently, so I can’t speak to the availability of evidence in the past from my own experience. But I can speak to the experiences of mentors of mine who were there, and who suffered professional retribution as a result of their adoption of ways of thinking that you seem to believe were not widely available for review during your training. I can also speak on the numerous books and articles that I’ve read which were produced during this time. That they were produced in the 60’s, 70’s, 80’s and 90’s proves that this information was out there, difficult to locate or not.

My point is not that you should be vilified for missing this information, or that you should bow at the alter of progressive psychiatry and make amends for your “sins”. But it upsets me that when commenters on this site, including me, have brought these issues to your attention you have denied that you may have had a role in your own lack of understanding. Many of us have fought hard and paid dearly for our unpopular viewpoints, and to have someone who has only recently come over to our side claim that they can’t be faulted for their past conventional views, which we have been fighting for some time, stings a bit.

I again offer these comments with genuine respect and repeat that I’m not attempting to be a bully, forcing you to engage in any activity that you do not feel is warranted or congruous with who you are and what you’ve been through. But I would hope that you can understand where I and others who share my views are coming from and not reduce our thoughts and feelings to Monday morning quarterbacking and Anti-Psychiatry bias.

Greg,
Isn’t it nice that we don’t have to agree on everything here. Each of us has our own viewpoint.

Sorry you “sting a bit”.

When people who were not there in my skin and shoes make presumptions about what I knew, didn’t know, could have done or should have known, they are engaging in Monday morning quarterbacking. It happens all the time.

Another way I see this is looking through the “retrospectroscope”. Perhaps there are more palatable metphors for the human habit of imagining that one could have done things differently had one been there. This goes on in the aftermath of lots of really bad happenings from ten-car pileups to genocide. We all would like to imagine we would have known better and that it could never happen to us.

We still kill more Americans “by accident” with cars each year than in our intentional wars. We’d like to think these won’t happen to us because we’re smarter, safer drivers.

Exactly! And it seems that the only people paying attention to it were the people who are trapped in the system! This is what I’m trying to get at; why did no one else pay attention to these things? If “patients” could get their hands on it, why couldn’t everyone else. People have to make choices. I understand perfectly why some psychiatrists prescribe pills rather than do talk therapy; they’ve grown accustomed to a particular level of lifestyle. I do believe that many of them turn a blind eye to the effects of the drugs that they perscribe and they refuse to listen to their patients. Not every psychiatrist does this, obviousely Alice is not one of these or she probably would not be posting and dialoging and scrutinizing and questioning. But way too many of them do; I watch it happen four days a week and I see the detrimental ways it affects people in their care. If they refuse to stop using these drugs on people then perhaps they do need to consider changing professions, since as doctors they vowed to do no harm. I had to change professions twice because I felt I could no longer work at them in good conscience because of changes that took place in my understanding of things. I had to stop teaching Religion in Catholic high schools because I felt I was expected to propagandize the kids rather then help them learn how to make intelligent decisions about their own faith lives. I had to leave chaplaincy work because I’d always been a Buddhist at heart and not a Christian. I was a wolf in sheep’s clothing for fifteen years and finally had to quit, even though I was a pretty good chaplain. So, I know how difficult it is to change what you do for a living. Why are some of these psychiatrists allowed to keep harming people. This is all that I want to know. I don’t hate them, I don’t want to hang them by the neck. I just want an explanatio as to why they are allowed to continue harming people when anyone else responsible for doing such things would be put in prison or fined heavily. It seems like everyone wants to dance around this issue rather than deal with it. I appreciate Alice’s efforts to reform the system, even if she’s just one, tiny person. Better to light one candle than to curse the darkness. We all must do what we can in our own ways to not only reform this broken system, we must carry out a revolution to totally change it. Too many people have died and are dying as we all sit here posting. Sorry that I’m not as erudite and good with words as everyone else. I too am searching for answers to what I consider are some very important questions. It is interesting to note that Alice’s blogs get more attention than almost all of the others, so something right is apparantly happening here.

I think that one reason Alice’s blogs get so much attention is the quality of the dialogue she both invites and sustains. She consistently engages with in a respectful way, and is clearly engaging in her own process of discovery as well. It’s the kind of discussion this site was created to host; not merely to advocate from one side or the other, but to engage in inquiry where the various perspectives meet, and see what evolves.
When I’ve been on teams that were gnashing their teeth at a psychiatrist, my call has been to not do what we were angry at the psychiatrist for; being so certain of our own point of view as to cut off all other options from consideration.
Of course, it’s hard, and I’ve spent a lot of time walking off anger after conversations with psychiatrists, sputtering with incoherent rage at the casual dismissal of other perspectives. It was the presumed weight of evidence, or at least hegemony, that the psychiatrist seemed to enjoy that raised the anger.
But on this website the bias skews the other way, and Alice has so far been the MVP MD as far as willingness to see where that goes. I’m not sure how long she can keep up a conversation with so many people, but her effort so far has created a lot of good for all of us.

It is a bit for me to juggle so many conversations. There is one me and (Woo Hoo!) a whole bunch of you. This is great. Unexpected. I’m so happy that so many folks are taking the time to speak up and be counted toward finding solutions.

Probably you’re going to get tired of hearing this:
We’re all in this together.
Best,
Alice

“Why do psychiatrists refuse to listen?” is the key phrase here. I kept begging my son’s psychiatrist all night through in my head “Please, please Dr A you could help him if you’d only listen” He was a nice man, he meant well and yet when I tried to speak to him about my version of events it was as if I was talking gibberish to him and all he came up with was “leave it to the experts”

Alix,
Forward him links to my posts if he will only listen to a psychiatrist. Foreward the link to MIA if he’s more open to the points of views of others.

I was taught by a very wise mentor that I have to adjust my use of language to meet the person I’m talking to. For example, if someone tells me he feels like his motor’s not running right, I’d better talk to him about his motor and not his heart and lungs.It’s part of human communication.

Yes, it’s his job to be open and listen. As an outspoken doctor, I’ve had no better luck getting my own doctors to listen to me over the years.

“What is getting between all doctors and hearing what their patients are saying?” This is a book’s worth.

Fuller Torrey used to have a very good understanding of the patients point of view.He also wrote an excellent book about homeless people that was very timely, following the evacuation of the State hospitals which coincided with the end of the Vietnam War.

He went off the deep end and was on 60 Minutes carrying brains around in buckets and explaining how he would make history by slicing them up and finding the cause of schizophrenia.

So he went from understanding the human mind to dehumanizing it.

The brains were in buckets, not jars, although he did have that tell-tale mad scientist look. No holes in the buckets that I remember.

Alice said: “It will take all kinds of people, maybe even the occasional psychiatrist, to get this boat turned around.”

Excuse me? In my opinion, it is the ethical *responsibility* of psychiatrists to turn the boat around.

I spend most of my daylight hours doing what psychiatrists should be doing, supporting people in tapering gradually off psychiatric medications. I really, really wish doctors would step up to the plate and do this.

Having to clean up after doctors — well, it’s not a pretty sight. I’ve contacted hundreds of psychiatrists asking if they will help patients taper slowly. I’ve gotten responses from about 20.

So who is going to do this, Alice? What does the existence of a couple of dozen patient Web sites to get people off psychiatric drugs say about the sense of responsibility that physicians bear patients?

Openmindedness and tolerance? All very fine, but talk is cheap. Action in the real world is what I’m looking for.

Altostrata,
Thanks for being out there and thinking. It will take us all to get things turned around.

You have suggested to me in the past that you think my energies would be best spent working in an office to taper people off medicines. Thanks for your thoughts on how I can best live. Advice and opinions are great, but we each have to find our own paths.

Perhaps if the rhetoric were toned down just a hair it would help others who could help hear the messages and respond. I doubt that many are willing to walk into the blasts of accusations and name calling. At times, I have doubts concerning my own skin being thick enough for this.

If your approach is working to achieve your goals, good. If not, maybe it’s time to try something a little different. Perhaps not.

Altostrata,
Others may be interested in doing what you do from your website, giving advice to people about getting off their medicines. Have you run into any legal stumbling blocks with this that others should avoid? You’ve told me you can’t get any doctors to help you do this. It sounds like the market is wide open to provide this type of online service.
Alice

Alice, patients are helping each other with safe tapering because they have no other options. Many people cannot find a doctor who has the slightest sliver of a clue.

I am not a doctor, and I do not presume to offer medical advice.

I do this to help other patients because I have had severe neurological damage from Paxil withdrawal — incompetently supervised by UCSF Psychiatry — for more than 7 years, and been disabled from it for more than 3 years.

I don’t want to see other lives destroyed as mine has been. My Web site is not a business.

All the patient-run Web sites for withdrawal cannot begin to reach the millions of people who need this information because of vast overprescribing and mistreatment.

I guess an enterprising doctor could find a way to privately support patients online. I believe an in-person visit is necessary to establish a legal basis for prescribing, or a consultation relationship directing a local doctor to write the prescriptions.

The solution I see is for MDs who grasp the need for individualized tapering to provide this service face-to-face for patients locally, and to teach other doctors to do it.

Patients experiencing the stress of withdrawal would greatly benefit from face-to-face support. One trauma many experience is dealing with a total loss of faith in medicine. Another is what I call unpatienting oneself — getting beyond the labels and finding yourself.

At one time, Mark Foster was going to open a clinic in Colorado for getting people off medications, and I predicted people would be coming from all over the world for his help. But he’s diverted into speaking on mental health reform.

Offering this service requires a deep concern and dedication to patient safety that I’ve found to be in short supply among doctors. It’s also a reflection of an appalling lack of basic knowledge. They know how to get patients dependent on the medications but they don’t know how to get them off.

Sorry to use up all the Reply buttons, but it took me 4 years to find a doctor to help me with my neurological damage from Paxil, and who understood why someone would need to taper very, very gradually. And this is not in Podunk, it’s in San Francisco.

“The real question is: How could I have known?”
..
You could have known if you were deprogrammed from the entire system. Then all things like this would be clear to you.
…
If you were like myself -if your personality was somewhat fragile, dysfunctional, didn’t work and gradually broke down. Then if like myself, you developed full blown schizophrenia, episodes of pure madness, experienced social and material deprivation, abuse and poverty, ending in then sent to the phantom zone on emotionally deadening meds for two years…and then after all that you if you found a way to become emotionally alive and functional with the help of some others, then I pretty much guarantee you , you will be cured of your socialization, you will become a ‘tabla rosa’ again like a new person, your ‘Sockpuppetry ‘ your programming, your brainwashing will shatter, and you will become a clear-thinking human being without an identity dysfunction.
…
Alas! This is the only method I know how to deprogram humans. I don’t think it is so great. I can see clearly the identity disease infesting society, but I have not known of any methods by which to cure it. I can make many suggestions though, such as living in a foreign country , spending time in meditational retreats etc, but there is no guarantee.
When I became alive as myself,a full personality, at the age of 30 one of the the first things I understood was that I was fundamentally different than almost everyone else,including those who ‘cured’ me, in respect to identity. At first I was very under-confident in challenging other about this and it took years of experience to be able to verbalize what this ‘thing’ was all about.
We live in a system which is fascist, murderous, tyrannical, ruthless and exploitive from the top down. It exists and is maintained because the population is socialized and propagandized into a state of “induced identity dysfunction” or “induced identity disease”. They cannot extract their own identify from the identity of the system. They cannot oppose the system, because the system is internalized in themselves. For instance people try to think about economic problems by using misleading paradigms with which they have been socialized by the media of their rich exploiters. They are missing critical paradigms and the paradigms they have are distorted.
The entire population needs mass deprogramming, I wish the aliens would please take them to mars , get the job down and then return them. If a population want to be free they will have a zero tolerance for oppression and they will thrown down their oppressors immediately. Zero tolerance for oppression is like the need to breathe – you reject oppression like you reject death and to the death.
But compromised identities do not want to be free – they don’t understand freedom both personal and material.
It is very sad.
..
The buckets are in a much larger system of oppression that goes to the root of identity. Propagandists misuse the natural tendencies to CORG and BIRF. Many thing go on here in this identity process – people are taught to empower themselves, their egos, with illusions and to support evils that provide those illusions. They are indoctrinated to think that they actually ARE other things that they are not. They are indoctrinated to transfer emotions from one thing to the other without critical inspection or challenge, they are taught to avoid to confront, challenge or change, they are taught to make secret pacts with the powers that be – support their evil and they will get a slice (paltry though it may be), they are encouraged not to see the horror of the system they live in, they are whipped by happy face fascism to avoid the perception and the actualization of the negative, to avoid the resilience of enduring the real. They are taught to avoid and abhor their negative emotions when it is quite natural for accepting human being to enjoy and even relish all their negative emotions and differentiate between the emotions themselves and the events that cause them.
..
The society is seeing a level of evil never before achieved in social and propaganda control due to technology. The masses are under propaganda and socialization assault 24/7 – almost no one escapes. Every aspect of all lives is being invaded and harnessed to the wheel of fascist controllers. The controllers are no longer even relevant, the system itself becomes stronger than the controllers.
Everything will get worse, even as you are thinking it will get worse it will have already become worse because what is going on is hidden and obfuscated for the public consciousness. Only we can hope some kernal of light will be preserved somewhere by a few, and hidden somewhere to survive the coming dark ages.

How could you have known?
Understand that there is a ‘system’ and that the system is not you. Vomit it all out. Everything. Everything you have introjected from birth to now. Purge your lives!
And rebuild.
…
All social problems can be so easily solved, The world can be a paradise. It’s so easy. But people have been taught to not WANT it to be a paradise, therefore they actively prevent it from being a paradise.
Slice the Gordian Knot by understanding the sword of pure power. Clear away the propaganda and the cobwebs. The world is the way it is because the people in power want it that way and the masses have been socialized to want it that way as well. The masses are the extensions of the egos of the powerful.
Break the bonds and cut the strings.
I am one of only a very few. Before the internet I hid who I was and thought I might be the only one. I knew I was in a system that didn’t want people to be cured and that to be cured was in worse social standing than to either be normal or ill. To be cured is to be a ghost in the system, something that is not supposed to exist.
The system and the people in the system get what they want, they get what they desire. If they don’t want the ill to be facilitated to become well,then that’s what they get and have gotten.

Damn! I wish I could write like you do! You are powerful and I’m glad that you discovered the internet and claimed yourself becuase you are mighty. Yes, you are different and that is what is so wonderful. I’ve felt different all of my life from the time I was a small child. As a kid I woke up one morning and said to myself, “It’s okay to be different, even if you’re the only one of your kind in the whole world!” I’ve met a few others but you’re the first one I’ve “met” who can write and use words this way. Thank you for your post. I hope you come back here and continue to post because you have a way of hitting the nail right on the head, straight on. I agree with all that you stated. What ideas do you have for helping to change all of this craziness?

“The real question is: How could I have known?”
..
You could have known if you were deprogrammed from the entire system. Then all things like this would be clear to you.
…
If you were like myself -if your personality was somewhat fragile, dysfunctional, didn’t work and gradually broke down. Then if like myself, you developed full blown schizophrenia, episodes of pure madness, experienced social and material deprivation, abuse and poverty, ending in then sent to the phantom zone on emotionally deadening meds for two years…and then after all that you if you found a way to become emotionally alive and functional with the help of some others, then I pretty much guarantee you , you will be cured of your socialization, you will become a ‘tabla rosa’ again like a new person, your ‘Sockpuppetry ‘ your programming, your brainwashing will shatter, and you will become a clear-thinking human being without an identity dysfunction.
…
Alas! This is the only method I know how to deprogram humans. I don’t think it is so great. I can see clearly the identity disease infesting society, but I have not known of any methods by which to cure it. I can make many suggestions though, such as living in a foreign country , spending time in meditational retreats etc, but there is no guarantee.
When I became alive as myself,a full personality, at the age of 30 one of the the first things I understood was that I was fundamentally different than almost everyone else,including those who ‘cured’ me, in respect to identity. At first I was very under-confident in challenging other about this and it took years of experience to be able to verbalize what this ‘thing’ was all about.
We live in a system which is fascist, murderous, tyrannical, ruthless and exploitive from the top down. It exists and is maintained because the population is socialized and propagandized into a state of “induced identity dysfunction” or “induced identity disease”. They cannot extract their own identify from the identity of the system. They cannot oppose the system, because the system is internalized in themselves. For instance people try to think about economic problems by using misleading paradigms with which they have been socialized by the media of their rich exploiters. They are missing critical paradigms and the paradigms they have are distorted.
The entire population needs mass deprogramming, I wish the aliens would please take them to mars , get the job down and then return them. If a population want to be free they will have a zero tolerance for oppression and they will thrown down their oppressors immediately. Zero tolerance for oppression is like the need to breathe – you reject oppression like you reject death and to the death.
But compromised identities do not want to be free – they don’t understand freedom both personal and material.
It is very sad.
..
The buckets are in a much larger system of oppression that goes to the root of identity. Propagandists misuse the natural tendencies to CORG and BIRF. Many thing go on here in this identity process – people are taught to empower themselves, their egos, with illusions and to support evils that provide those illusions. They are indoctrinated to think that they actually ARE other things that they are not. They are indoctrinated to transfer emotions from one thing to the other without critical inspection or challenge, they are taught to avoid to confront, challenge or change, they are taught to make secret pacts with the powers that be – support their evil and they will get a slice (paltry though it may be), they are encouraged not to see the horror of the system they live in, they are whipped by happy face fascism to avoid the perception and the actualization of the negative, to avoid the resilience of enduring the real. They are taught to avoid and abhor their negative emotions when it is quite natural for accepting human being to enjoy and even relish all their negative emotions and differentiate between the emotions themselves and the events that cause them.
..
The society is seeing a level of evil never before achieved in social and propaganda control due to technology. The masses are under propaganda and socialization assault 24/7 – almost no one escapes. Every aspect of all lives is being invaded and harnessed to the wheel of fascist controllers. The controllers are no longer even relevant, the system itself becomes stronger than the controllers.
Everything will get worse, even as you are thinking it will get worse it will have already become worse because what is going on is hidden and obfuscated for the public consciousness. Only we can hope some kernal of light will be preserved somewhere by a few, and hidden somewhere to survive the coming dark ages.

How could you have known?
Understand that there is a ‘system’ and that the system is not you. Vomit it all out. Everything. Everything you have introjected from birth to now. Purge your lives!
And rebuild.
…
All social problems can be so easily solved, The world can be a paradise. It’s so easy. But people have been taught to not WANT it to be a paradise, therefore they actively prevent it from being a paradise.
Slice the Gordian Knot by understanding the sword of pure power. Clear away the propaganda and the cobwebs. The world is the way it is because the people in power want it that way and the masses have been socialized to want it that way as well. The masses are the extensions of the egos of the powerful.
Break the bonds and cut the strings.
I am one of only a very few. Before the internet I hid who I was and thought I might be the only one. I knew I was in a system that didn’t want people to be cured and that to be cured was in worse social standing than to either be normal or ill. To be cured is to be a ghost in the system, something that is not supposed to exist.
The system and the people in the system get what they want, they get what they desire. If they don’t want the ill to be facilitated to become well,then that’s what they get and have gotten.

Last night I finished David Healy’s Pharmageddon. I urge everyone to read it. Healy writes with the canny knowledge of someone who has been on the inside and can think like the marketing whizzes who’ve engineered the “holes in the buckets” that allow only PhARMA-friendly information to easily register with psychiatry and our culture. To see how we all got to this point, read Healy. (I know he wrote an inexplicably rosy account of ECT too, but he’s also taken courageous stands against PhARMA and taken his lumps for those stands).

“If I did therapy exclusively, I would have to take a 40 – 50 percent pay cut. Most psychiatrists, like me, choose a psychopharmacology practice.” (p. 194)

Moreover, most psychiatrists depend on the psychiatric establishment for their jobs – and the establishment won’t employ psychiatrists who demote medication from it’s privileged perch. Healy isn’t totally anti-drug, yet he lost a post at the University of Toronto for stating the obvious – that SSRI’s don’t really work all that well. Loren Mosher was pushed out as head of Schizophrenia Studies at NIMH for advocating psychosocial interventions. Grace Jackson was pushed out because she wouldn’t prescribe, and then she had to spend thousands defending her license. Peter Breggin had to defend his license too.

Some, like Alice, who are willing to take some heat for their views, can create positions where they are relatively freer of these constraints. But that is not a choice most psychiatrists are either willing or able to make.

So there it is – money and jobs. They make it a whole lot harder for most psychiatrists to see what is easier for LCPC’s, social workers, some psychologists and other thinkers to see. A problem can’t be fixed unless we look it in the eye; psychiatry won’t do it – but we’d better, if we want to succeed. PhARMA’s marketing is a huge factor, but psychiatry embraced the hype for its own reasons too: the psychiatric establishment jumped with enthusiasm on PhARMA’s train as a way to wealth, hoped-for prestige within medicine, and hegemony over the “mental health” establishment.

It’s also worth remembering that physical cures for mental problems have long been a fond hope of many – not for venal reasons, but because “it’s physical” is historically the default reaction when we become desperate over mental problems that seem intractable, not readily explained by psychosocial factors. Well meaning people throughout history have mortified the flesh, drilled holes in heads, almost drowned, cold wrapped, metrazol shocked, insulin coma-ed, lobotomized, ECT-ed, and drugged people. Sometimes because of sadism, but often out of anguish over suffering they feel helpless to prevent, hoping the physical would work.

It’s easy to see how, following the miracle drug discoveries of antibiotics and polio vaccines, and the general ascendancy of “science” in our lives, something as sanitized as taking pills could hold such hope for those who desperately want to relieve mental suffering.

But hope isn’t a substitute for reality; and the reality is that the psychosocial, the vast permutations and combinations of billions of individual human brains interacting in pairs, families, groups, religions, nations, is far more complicated and promising – and far less scientifically explored – ground in which to find answers to our mental problems. PhARMA spends $60 billion a year on research – what would we learn if even $10 billion were devoted to psychosocial research.

Lots of digression here. The long and short of it: PhARMA’s brain washing is big; money and jobs are big; the longing for the simplicity and clarity of a physical answer is big. And nobody should have to wear a hair shirt about their own past blind spots. We are not born with buckets on our heads, and we can still think with each other.

You are very right. There is no paying work for a psychiatrist who will not prescribe drugs. This is not a “pay cut”. This is zero. Most of this is happening through other channels now anyway, cheaper ones like PAs, NPs, primary care, obgyn, psychologists. Even the social worker lobby want in on the act.

And, ah, the student loans that have everyone in a lifetime of financial disaster today. There is no bancruptcy discharge for these.

“Sometime, during the course of your loved one’s illness, you may need the police. By preparing now, before you need help, you can make the day you need help go much more smoothly. There are three things to do.”

“the fact is that some families have learned to ‘turn over the furniture’ before calling the police. Many police require individuals with neurobiological disorders to be imminently dangerous before treating the person against their will. If the police see furniture disturbed they will lusually conclude that the person is imminently dangerous.”

The bottom line is Fuller Torrey and TAC and associates are not Pro-patient, they promote articles and stories about violence in mental health patients, they feed the media hype and the stigma that mental health patients are violent, they back legislation that removes freedom of choice such as forced (court-ordered) medication compliance and more.

This is Mad In America where people who have been harmed and discriminated against, held against their will, forced to be strapped to gurneys, injected with antipsychotics against their choice can have a voice–and mine is from the perspective of seeing these atrocities happen to my child. Once you see a child strapped to a gurney with a spit shield attached, and the wrist’s being cut from straps too tight, you tend to have less tolerance for ppl like Jaffe or Torrey, and their agenda.

Yes, and I have witnessed many atrocities within the system by being a visitor inside locked psych wards…horrible things, such as forced injections (yes in view of visitors via a ‘take down’ by staff)etc. being inside, has at times traumatized me for what I saw.

And if it was traumatizing for you, how much more so for he person it happened to. Paych wards, state hospitals, are supposed to be places of “safety” for people with issues but all too often they are not safe places and people are re-traumatized over and over again while they’re there. It’s also traumatizing for staff, those really good people who really do care. Everyone is affected by these kinds of things happening.

Any interaction with a psychiatrist can quickly turn coercive if you don’t watch yourself. They are by virtue of their powers, among the most dangerous agents of government power you can come across in your life. People must learn to withhold any information from them which can get them locked up and forcibly drugged.

Anonymous,
You do have to knwo what to say nd not say. The laws state real clearly the things a “designated” mental health professional, ED doctor, police officer must do if someone makes threats to self or others in front of them. They are bound by law. A person has to know not to say those things or behave in a threatening way. You are absolutely right.
Alice

‘She is not a danger to herself or others, when at her most distressed she needed someone to sit down with her and have a cup of tea and a chat (OK, maybe she needed that everyday for a week or two, but you get the picture), not years of injectable major tranquilizers.’

Not to much difference between this and physical murder.
Here is a way to simulate the med experience:
“Blink your eyes.”
That is two years or twenty years on meds. In order to have time and memory a person needs to have an emotional life.
===>
I was at a supposed community meeting. The only purpose of that meeting was to threaten the out-patients there with CTO’s. There was no sharing of experience in the ‘talk’ or discussion. It was a dictation to prisoners. The person doing the psychic police work was in a newly created district position in which the medial system was expanding it’s influence and control over a wide area.
If I am NOT in NAZI Germany of 1939, then just exactly where am I? What’s the difference?

===>

‘There are people who worked with people who were angry, violent and disruptive who did not use drugs. They have a track record of success.’

Anger and aggression are very under-rated and unfairly dis-respected. It’s the propaganda of the oppressor – ie ‘don’t fight back’.

We don’t live in a fair and just society – it’s more like a mass prison camp under propaganda assault and mindwashing 2/7.

Better angry than vacant, better angry than depressed, better angry than dead.
Health is being integrated and using what we got, not restricting ourselves to please social fascists or allowing them to dictate standards of ‘success’.

No, I don’t suppose this to be a “fair and just” society. I don’t think this is restricted to psychiatry. We are embedded 24/7 in marketing. True.

While I would never suggest than anyone succumb to the pressures and let go of the dream of making things better, I would make two suggestions.The first is about living a life built of anger. The second is about doing things that will result in being sucked up by the system as it currently exsits.

First. Anger is unhealthy and unhappy, especially when there is so much of it. When I feel angry, I feel bad. I want to feel better even while we work together on this. The hormones released when angry trash the body and unplug the thinking brain. Angry displays drive away others that could help. Is it possible that your anger could play into the other guy’s plan? Likely.

Second. The laws are unfair and the sytem wrong. But it is there now. Bashing yourself against the laws will result in you becoming yet another unsung martyr. What good can you do from there?

If you like the Nazi metaphor (and I’m getting it that some people here do) think of the French resistance fighters. They did not go out and throw rocks at German soldiers in the street. That would have meant one less to work for the cause of French freedom. They went underground and worked quietly.

We need all the clear thinking help we can get to turn things around.

My apologies to those that have been troubled by the Nazi rhetoric on this web site. Please hang around.

The science and the criticism have been around right from the start. You could have known, looking at it. You could have wondered, become curious, and investigated. Given the controversy that always has surrounded psychiatry. Indoctrination in med school, and drug reps cornering you may play a role. But others have been through med school, and have found themselves cornered by a drug rep, every now and then, and still, they’ve wondered, become curious, and investigated.

Cognition, the rational mind, indoctrinated or not, facts and data, studies, intellectual knowledge, biased or not, isn’t everything. Although our culture hardly is aware of anything else to exist, it’s nothing but an infinitesimal part of our being. And when you are restricted to live in your head — “Cogito ergo sum”– the bucket will always keep you from… Well, not knowing, but from being able to move on to faith.

I was at a hearing about deaths in psychiatric “care” last Tuesday: “Why do labelled people die on average 25 years earlier than the general population? What can we do to prevent this?” Among the presenters, there was also a colleague of yours, contributing with two short talks. In her second talk she focussed on bureaucracy and regulations making it almost impossible for staff to do their work properly. You might say, this was probably the worst choice of slant she could possibly have given her talk, with an audience consisting of, primarily, family who have lost somebody to psychiatry, and survivors. When she’d finished, and gone back to her place, a friend of mine, a survivor, horribly mistreated and traumatised by the system, came pounding, placed himself right in front of her — and he’s a huge guy, and when he’s angry you’re not in doubt that he is — and, pointing his finger at her, shouted: “This is not about your working conditions! This is about human rights!!!” And what did she do, far away from home ground, with no restraints and/or Haldol at hand? Well, she cowered on her chair, her head bent, and her arms over it for protection. The “expert”, the authority, the professional in the field of, well actually, being, in the field of existential suffering, who’d just given the most self-confident and self-complacent presentation on psych staff’s impossible working conditions. Unable to recognise, never mention deal with, existential suffering, with life, when it stared — and shouted — her in her face. Terrified.

Existential angst. Dizziness of freedom. If someone can’t muster the courage it takes to opt for free falling, they’ll inevitably choose deadness. The same deadness you don’t need science, facts and data, studies, cognition, rationality, intellectual knowledge to be able to see in the eyes of the psychiatrically drugged. But if you choose deadness, you choose to live in eternal fear of life. With your head bent, and in a bucket, with your arms up and your hands holding on to the bucket, for protection, cowering on some chair, if it’s at a hearing at the Danish Parliament, at your office, at home, wherever. And you choose to live in denial.

Even if you’d known, you wouldn’t have been able to see it, the obvious, the obvious absence of life. You couldn’t have allowed yourself to look, and face your own terror. It takes a certain amount of suffering to overcome the fear of this terror, and muster the courage to opt for free falling. The truly sad thing is that our culture’s dizziness of freedom in its desperate attempt to protect itself from this freedom has declared it a disease, and those, who are suffering enough to find the courage inside themselves to make an attempt at free falling, diseased. The cure for this disease is deadness, and, since the body is a metaphor, eventually also death. In a pill.

Marian,
You’ve obviously put a lot of time and effort into your comment here. Thanks for that.

You make assumptions that I have not questioned, not asked, not read. You also assume that psychiatrists don’t question, ask or read. These are poor assumptions to make. You throw away many kind people who could help.

I’m impressed by the level of anger expressed in your post. Not your own, perhaps, but certainly through the descriptions of the behaviors of others.

As a human rights activist, I’m surprised that you would vividly describe and then justify your large male friend’s loud threatening behavior toward a woman. Of course, she would be frightened. I’m not sure what one can infer from this except that she was afraid. Of course.

When one justifies aggression in words and behaviors, one sides with aggression everywhere.

you make some pretty big assumptions when you choose to understand from my comment that I don’t believe psychiatrists ever question, ever ask, ever read. I’m sure they do. My observation though is that their questioning, asking and reading is rather limited to science. Science is fantastic. But it’s far from everything. It doesn’t equal life, and it is only one out of innumerable tools to understand life.

I didn’t say, either, that I condone the behavior of my friend. I don’t. But I do understand it. What I tried to make you see, describing the incident, and the psychiatrists reaction, is that the entire system is built on fear. Or existential angst. You can’t help people if you yourself are terrified of life, like this psychiatrist is.

I am an activist, yes. But I wasn’t angry when I wrote my comment. Far from. Another assuption, another prejudice, and, hm, do I sense some anger?

Marian,
My reading is not limited to “science” at all. How dull that would be.

I read fiction (Terry Pratchett is an all time favorite), poetry (Rumi translated by Coleman Barks and Walt Whitman. Jimmy Carter is a fine poet), how-too, self-help, history, anthropology, biography (Lillian Carter was a wonder), education (Must read: Gatto), arts and crafts , cooking (“Wild Fermentation” is great), health and fitness, nutrition, philosophy (Dalai Lama’s good). Heck, I even read investigative journalism (check out Robert Whitaker’s books). Oh yes. I do read science. I love natural sciences like ornithology and botany. Physics is fun where it bumps up against philosophy.

Thanks for taking an interest. How else can we get to know each other here unless we can step past assumptions?

From your description (I wasn’t there) it sounds like the poor woman was terrified of a big, loud threatening male up close. That would work to generate fear in most folks. Probably on me or you as well. Well, maybe not you. 😉

You’re missing a (or some) steps in your logic. Scaring a woman does not equal psychiatry being “fear based”. Psychiatry may be fear based. Scaring a woman with direct threats to her physical safety doesn’t prove this.

Me angry? Heavens no. I’m not a human or anything. I’m one of those mythologic psychiatrist creatures.I just do “existential angst” 😉 But thanks for asking. It’s good to hear concern for my wellbeing here. I just got back from a run. It does wonders to help manage those pesky human emotions.

I understand Marion’s goal clearly. And I don’t see this man as being violent (forcing him on medications that don’t help, this is violent, taking away his human rights, this is violent). That is, if you are looking at violence as something to not condone. Someone pointing a finger at another and shouting isn’t violent, in this case it’s preventing violence. They aren’t violent thoughts either. Violent thoughts (thoughts condoning and also in collusion with violence) would be fussing about bureaucracy and people not being able to do their jobs, when most of this entails drugging people to lose the ability to heal, something which has become an annoyance to the psychiatric traditions, because this points out what healing is and that they aren’t accomplishing it with the “medications” and other “biological” treatments. Pumping someone up with Haldol because they allow their frustration an exit route, rather than sublimating it into inhumane control tactics, is violent. What’s violent is not seeing the human rights abuses going on, and then fussing about “working conditions,” when this work is taking away the living conditions of others.
This man walked away, said what he couldn’t hold back anymore, and didn’t spend the rest of his day in angst that the truth might come stalking him to leave him in terror. Neither did he have to see his outburst as terror in order to validate a phobia of the truth, whatever form it took. And who is supposedly angry? Are the drugs than also “angry” because they don’t work and it’s infuriating. Is that a personality flaw of the chemicals? Do other chemicals have the right attitude? The man was upset. He had been through living hell because of the “work” this woman does, and she’s complaining about her “working conditions.” Was he supposed to sublimate his anger and hire thugs to take care of her? The kind of thugs that violently inject haldol into anyone in an asylum who dares to not sublimate their anger into getting approval from fear based control tactics. This man didn’t perpetuate the matrix of sublimation and denial by turning anger into a self perpetuating imprisoned force. And I’m not saying that there aren’t perhaps better ways of responding, but this is after the fact. And he wasn’t left cowering believing he needed haldol or restraints against himself or others.
And saying that Marion was apparently “gleeful” about all of this, when she clearly pointed out it was an expression of existential human suffering: If one were to take what you said seriously and logically; it would be a personal attack on Marion saying she’s gleeful about someone exploding rather than that she sees it is someone going through existential human suffering. And that’s what she said. Very clearly. The rest is aspersions on her character and implying things she never said. And Marion clearly points out the kind of deadness that doesn’t see what the drugs do to people, that causes one to fall into such a system; and that this is clear to see from the beginning; before anyone gets into the system and prescribes any of these “medications.” Marion also never makes any assumption about people never questioning, she simply states that the answers were there the whole time. Are we supposed to ignore that the answers were there the whole time in order not to be accused of slandering a whole group of people who clearly didn’t question until it was too late? Are people that don’t get involved with insinuating that the people who didn’t question will never question? Did you enter the psychiatric profession in order to learn that the organic model was completely fraudulent? Was all evidence of this nowhere to be found? Why didn’t you see the evidence? Is someone assuming you weren’t questioning anything in bringing up that the evidence was there and you could have questioned what you were told ?

correction: “Are people that don’t get involved with insinuating that the people who didn’t question will never question?” This should read: “Are people that don’t get involved with psychiatry insinuating that the people who didn’t question will never question?”

Nijinsky,
You’re right. My interpretation of the tone of her report as “gleeful” certainly overstepped my usual boundaries of decorum. You will see I have intentionally edited this out of my post because of your point here. This is a public apology for using the word “gleeful” in my response. Only she can know the truth of her personal feelings with regard to her own post. Thanks for pointing out when I step over the edge.

Yep, I have more. I think you should sue the school you went to for your training, and um; you should instigate a take-over with all the money you’ll get. About 70 trillion should do it. Do you have a good lawyer?

Well, it’s extremely presumptuous of me to think that a mere 70 trillions dollars would facilitate in a takeover of the schools promoting the biological model of mental illness. Given that, we could easily get a second financial collapse within a decade, thanks to the abundant and exorbitant investment in psychiatric drugs losing their value, I think it should be more like 1,000,000,000,000,000,000 dollars. That should do it! ( 1 think that’s a million trillion there ). That way the whole world will be in debt to you for more than ten thousand years. All from this one legal case against the drug companies!

Actually after I got over trying to be funny. And wondering whether making the drug companies accumulate a debt (facilitating a financial collapse, and then inflation) that would make an aspirin cost a trillion dollars, and people not being able to add up the zeros anymore, and then having to do the logical and give up on money, and the root of all evil being gone… I don’t know how feasible this would be for a group of psychiatrists to actually sue various institutions of higher education and their drug company alliances. The legal issues are more than a few that I could think of. And I’m just spinning things out…I’m not a lawyer, and don’t really the relevance of any of it.
1) Teaching about an alleged chemical imbalance, as if it’s proven fact; and then integrating this with 10 years of medical training; which contradicts said imbalance as coming from anything but the treatment.
2) In the process accumulating immense debt for anyone who goes through this, and expecting them to pay back this debt practicing a method which completely contradicts itself, and which statistically causes the problems it is said to be healing.
3) Emotional abuse caused by the shock of finding out that one of their primary goals as a professional (that of helping clients to maintain a healthy chemical imbalance) was taught to them in a highly fraudulent manner.

And I don’t know what it would do for 50 or so psychiatrists to get together and make such a case against various institutions..

I don’t know if the legal system which seems to be intent on bankrupting everyone with guilt, would do anything but make matters worse.

Even when a hospital nearly killed my oldest child through the use of another child’s chart, missed xray diagnosis and the wrong medicines, I did not sue. I did speak up. But I’m not a law suit pursuing kind of person. From what I’ve seen with law suits (limited experience) the only winners are the attorneys even when the suit is “won”. (This is not meant to be bashing of attorneys. They work for a living and have to be paid for their time and services like anyone.)

Alice, no need to apologise. Misunderstandings are only human, aren’t they?

On another note, I shouldn’t have used “science”. I used it in a pars pro toto way to represent the entire mindset of our culture. The technological “Cogito ergo sum” mindset. It doesn’t matter what you read, if it’s the Dalai Lama, Rumi, the mystics. You can have all the literature on your shelf ( http://www.youtube.com/watch?v=IlnSHNyn7qQ , 9:20), you can even have read it all. The problem is the bucket, the mindset. But you have a choice. And when you suffer it is time to make a choice between the bucket and listening to, well, yourself, or your self. The psychiatrist I talked about above suffered. She was under attack. Not physically. My friend wasn’t going to hurt a hair of her head. But she had assaulted him, she had ridiculed his own pain (and actually that of the vast majority of those present), and he acted in self-defence. She wasn’t aware of her doings, or she would never have chosen to give the talk she gave. And that in itself IMO is disqualifying her as a helper. Unawareness of oneself is not a good basis for helping others through their struggle for awareness. My friend was trying to make her see her unawareness. But instead of forgetting just for one moment about the bucket on her head, she chose to hold on to it, tight. And all she could see through the holes of her bucket was meaningless madness attacking her, one of the loonies losing it, where are the security guards?! Not: OMG! I see you, I hear you, I made a mistake, I am so sorry!

My emotional reaction, although it doesn’t really matter, was sadness. The kind of sadness that is expressed in an unequalled way in Strindberg’s line “Human beings are to be pitied.” While the Swedish original “Det är synd om människorna” unfortunatelydefies any attempt to be translated into any other language without losing at least some of its sentiment.

Marian,
I’m a library user so I read them but they’re not on my shelf.

The bucket is a big deal. It is our belief system. This is part of the human condition. I work on making more of mine on my own by exposing my head to what I want in my belief system and avoiding the media. We all got one. I kind of have fun tipping mine up and looking around.
Best,
Alice

Nijinsky,
Thanks for the link. I have seen lovely, skilled clinicians in the crisis area I’ve worked in talk people down. This is always the best way.

I also know one lovely skilled worker who was slashed badly with a knife by a customer in the front office of a clinic because he walked into the room. No talk time in that moment.

I remember long ago (I risk buckshot on this one) a gentleman who had injested considerable PCP (veternary tranqilizer/anesthetic) and was on a crowded street fighting wildly with a knife to cut his own parts off and anyone who was near. There was no talking that would get through the drug confusion and agitation. This was decades ago. I don’t remember more about what was going on except that PCP (angel dust) was big in New Orleans then.

For most things, I can see more sides than two. Maybe this is my “flaw” as a doctor

Different things work in different situations and with different people on different days.

Alice, what buckshot? Why? Certainly none from me. Of course there are situations that can’t be dealt with with talk alone. Especially when substance intoxication is at play, if it’s PCP, or alcohol, or prescription drugs (!). I don’t know about the U.S., but in most European countries we have laws in the regular legislation that allow, even demand, everybody to intervene at a dangerous situation, if necessary using physical force, to prevent the danger. But these laws also say that no one is allowed to use more physical force than absolutely necessary to prevent the imminent and obvious danger. They don’t allow for the prolonged use of force that mental health laws allow for. They don’t allow for anybody to use force against someone else just because they might, at some point in the future, present a danger to self and/or others, while no one can say if they ever in fact will present this danger, and they don’t allow for interventions that are out of all proportion to the actual situation. Mental health laws do allow for all of this. They legalise assault. Anybody believing that assaulting someone will prevent (further) violent reactions, i.e. actions of self-defence, from their side must be incredibly naive, and — dangerously — ignorant of human nature.

Aside from that, I don’t like the expression “talk somebody down” much. I prefer “meet people where they are at”.

Certainly not you. But I am learning what topics are “hot buttons” here and introduce them with caution.

How is one to immediately know that a dangerous situation is the result of drugs and alcohol? When the knife is swinging or the fists punching and dangerousness is occuring one cannot always know the immediate cause. One is morally and legally obligated to make things as safe as one can as gently as one can.

As you say “we have laws in the regular legislation that allow, even demand, everybody to intervene at a dangerous situation, if necessary using physical force, to prevent the danger.” We are also bound, in this country, by both morality and laws, to use the least force necessary.

I met this specific gentleman when I came to work in a psychiatric emergency area. He was already in restraints. The PCP in his blood was discovered only after the police brought him in.

PCP has a tricky way of repeating on a person based in its metabolism. A person can seem well out of the grips of its fury and then “relapse” hours or days later. There can be a return of the drug effect and more assaultive behavior. This is unpredictable. This did happen when he was up around around later a few hours later. I’m certain that the necessary action taken to make the small, crowded area was hard on everyone there. Still. What were the choices?

Long ago, when I worked in this emergency hospital area as a part of my training there was not separate place for A and D related assaultive behavior or separate legal codes for responding to dangerousness. And yes, the dangerous behavior had to be immediate and witnessed to bring you there.

This is not meant to be coming down on the “side” of forced drugging and restraints or “against” it.

My point is that everything on this planet has more than two sides. Sometimes there are as many “sides” as there are people.

Thanks for reading and commenting,

Alice

PS: The phrase “talk somebody down” was used in quotes as I was responding to another commenter who used this phrase. Of course there are other ways to say this. I also like your phrase “meet people where they are at”. I feel a better sense of communication when I use the other guy’s words and meet him where he is.

I really think this has got out of hand. To begin with, this began with a story of a woman, who clearly has had people assaulted in the asylum, physically assaulted for simply not taking her “treatment” which doesn’t statistically work and which actually correlates with a whole new wave of violence and disability; and this woman, instead of acknowledging what she has done, fusses about her working conditions. This is seriously comparable to people that use torture for mind control complaining about their working conditions. And then someone, quite angry and rightfully so, doesn’t assault her, but shouts and points his finger. She might consider that were she in his position, and he in hers, and she in an asylum as a patient, was she assaulted by this man (which she wasn’t) that she wouldn’t have had the right to even call it an assault, wouldn’t have received any protection, and holding her hands over her head would have been seen as resistance to treatment.
An now, you can turn the whole thing around, which is valid, and then say that perhaps this man responding in an aggressive way doesn’t see that her assaults come from existential suffering. But the difference is, she actually is in the habit of condoning such assaults, does it as a profession, and was complaining about the working conditions in which she maintains such assaults.
Also, I shared the link from Peter Breggin’s radio show, with him interviewing Richard Gottlieb and his amazing story, just to remind people what kind of a complete turn around can happen when you use empathy. That’s all. And I don’t believe that this is in any way any kind of danger to share a story that there’s another way. I even believe that when you have this perspective, this will effect what you think, and thoughts are more real than anything you can measure scientifically. There is a cause and effect between your belief system and what you encounter in life. You perhaps won’t encounter the difficulties in life you might, which would simply be showing you what a lack of empathy and an investment in fear can lead to. I’m certainly not saying sit there and do nothing when another is being attacked. But when you don’t hate an attacker and are actually trying to prevent violence, instead of looking for an excuse to implement it, this makes all the difference.

And while we are on the subject of forced drugging, and how many patients are coerced or court-ordered to take the meds; let us not forget about true informed consent. How many patients were seriously told of the side effects of their drugs, or given the choice in which one they were placed on? Inside the psych wards I have heard patients begging docs to remove certain meds because they already had a bad reaction to it–and they were not heard. One woman was upset, wanted to call her attorney..the louder she got is when the staff came out and did a forced floor restraint and injected her w a B52. She sobbed, she was wailing that she wanted to call her attorney and it never happened. She sat on the floor in a puddle of tears, at my feet. It was atrocious treatment that I wish I did not witness, but I have witnessed it.

The bucket. the holes are called “schema”. these concepts are actually well researched in behavior chain analysis. One kind of schema, is called a “narrative”, is essentially how an individual translates the rules, or expectations of culture to one’s personal conduct. advertising and marketing operate within these principles.

Alice, I appreciate your essays and your continued presence and openness on this website. It takes fortitude that not everyone has. I for one want to keeping hear more from the perspective of those psychiatrists who want to convince other psychiatrists just how messed up modern-day psychiatry has become (even if I might not always agree with point X from psychiatrist A, or point Y from psychiatrist B, or even point C from survivor Z). Okay, the following got a little long…!

Some researchers & writers tend to think that our frontal cortex is the most “evolutionarily advanced” thing around, and that for most people, it’s our frontal cortex — so-called rational thinking — which is in charge the most. But because the frontal cortex has changed so much in a relatively short (evolutionary) period, and has gotten much less time to work out its new kinks and oddities, I wonder if it’s also the most fragile, and most subject to the whims of the much longer-established self-regulatory and emotional apparatus (i.e. limbic system & brain stem) below it.

But some researchers have begun to notice more just how often we can get things wrong, even major things. I read that for people who have spent years nurturing certain beliefs, and have strong feelings about those beliefs, if they hear evidence against those beliefs, it can often paradoxically strengthen the beliefs intead of weakening them! This is an unfortunate side of human nature. How do we best change people’s beliefs (about psychiatry) if our arguments against it can paradoxically strengthen those beliefs? It’s a hard problem.

About a year ago I got into a kick reading books such as:
– “Wrong: Why Experts Keep Failing Us— And How to Know When Not to Trust Them”, by David H. Freeman
– “Mistakes Were Made (but not by me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts”, by Carol Tavris & Elliot Aronson (I love that title!)
– “Sway: The Irresistible Pull of Irrational Behavior”, by Ori Brafman & Rom Brafman
– “How Doctors Think” by Jerome Groopman

On the more medical research front, one well-known article is:
– “Why Most Published Research Findings Are False” by John P. A. Ioannidis.

More specific to psychiatry (among many, of course) is:
– “Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?” also by Ioannidis. (Full text of both of these articles are easily found online.)

As the “Effectiveness of antidepressants” article suggests, psychiatrists have been potentially exposed to more than a thousand studies purporting to show effectiveness of antidepressants. They have paid dearly — in time, money, effort, and dedication — to learning and “strongly believing” what those journals and their own instructors kept drilling into them over and over.

And if psychiatrists dare give up (some or all of) those beliefs, they risk losing the life they have invested so much in. If they keep prescribing drugs, they get to keep their jobs, their house, their familiar mostly-comfortable life, etc. Even if they get sued, they can use (and fervently believe in) the fact that they were using “accepted medical practices” as defense against any allegations of “malpractice”. But if they fall too far outside of those “accepted medical practices”, then they’re on their own; they risk more loss from lawsuits, they risk losing their medical license, their income, their familiar way of life, etc.

I think that human beings in general use too much short-term thinking, and this can influence psychiatry. When a psychiatrist gives a patient a drug, and some patients seem to get better, the psychiatry education makes it easy to attribute that to the drug (as opposed to the placebo effect, or “regression to the mean”, etc.) And if a patient abruptly goes off of a drug, the patient sometimes does worse, which the psychiatrist easily attributes to how well the drug had been working. It’s the short-term presumed-cause-and-effect events that tend to make the biggest impression on us. And if a psychiatrist sees even a few of these (“they did better when I put them on drugs, and worse when they went off drugs”) events, it just solidifies this simplistic short-term belief, and hardens them from considering alternate possibilities that involve a longer-term perspective. Getting psychiatrists out from that won’t be easy, when they have invested so much of themselves in believing in it for so long.

And while I think that anger can sometimes be a useful motivating force, it can be too easily misunderstood by many people, including psychiatrists. A person may very legitimately be very angry for what psychiatrists and psychiatry have done to them, but many psychiatrists would just be completely baffled by so much anger from someone “they’re just trying to help”. There are unfortunately lots of psychiatric labels available to be applied to people who are legitimately angry for reasons that any given psychiatrist just doesn’t (or isn’t yet ready to) understand. I’m not sure if more anger will change their minds, or if it just solidifies their existing beliefs. (“Yet another poor soul who lacks insight into their condition!”)

And most people, (especially?) including psychiatrists, can’t handle too much distress in the people they see. They think their drugs are diminishing that distress, but in most cases it’s just suppressing (or oppressing) the distress. I’ve often felt that practitioners were (in effect) saying to me “We want to help you with your problems, but we don’t want to have to actually see them or deal with them!” It’s a hugely common cognitive error for doctors to assume that suppressing the visible appearance of distress (sometimes via implicit shaming) is the equivalent of alleviating that distress.

Maybe it won’t go out with a bang, but a whimper. The pharmaceutical companies appear to be slowly giving up on new psychiatric drug research. The existing psychiatric drugs are gradually falling off patent, which means there’s no motivation for the big drug companies to keeping marketing them so hard. Maybe it will slowly fizzle, hopefully replaced with better healing modalities (and not yet another oversimplistic approach that just harms and shames us in new and different ways).

Interesting use of metaphor and analogies of self interpretation, in these last two posts Alice?

In reflecting on humility you used the metaphor of a pond, muddy water and the flow of tears to articulate internal sensations.

Here you use “objects,” a bucket, a drill and the mechanical nature of drilling holes to articulate your mind’s sense of knowing?

Do these object analogies really ring true for you? Is this an example of our taken for granted learning of a language overwhelming dedicated to describing the external world?

The pond & muddy waters seem to capture the actual fluid nature of our internal world far better than a sense of objectivity the mind prides itself on “knowing?”

I make the comments because this type of mechanical logic seems to typify the categorizing of the human condition in the DSM, and why when I experience psychosis and that overwhelming sense of oneness so common to the experience, I’m not sure if its me or the psychiatrist who’s dissociating from the nature of reality?

“How could I not have known?”

Perhaps because its a myth that we are intelligent, rational and consciously self directed creatures, not driven by the immediate needs of self preservation?

Perhaps years ago you simply didn’t need to know, as securing self preservation, ruled each day as it does for all of us? Perhaps we are all guilty of acting more unconsciously than we care to admit to?

When we think in object oriented terms, are we really embracing the reality of our own nature, or distancing ourselves from it, with a sense of cognition that is becoming increasingly insane?

Powerful psychotropic drugs for two year old’s, surely the height of insanity?

Art has a way of expressing the nature of reality that logic misinterprets, especially when the logic is taken for granted.

If I lay here
If I just lay here
Would you lie with me and just forget the world?

Forget what we’re told
Before we get too old
Show me a garden that’s bursting into life _Snow Patrol.

David,
Thanks for a lovely post and taking the time to explore my use of metaphor. I like metaphor (and poetics) because they cast a wider net of understanding for a visual thinker like me. I move a past words in understanding with metaphor. The ones I choose work for me at the time. They may not ring true for all or even anyone else but me.

I have no need for metaphor for this thing:

Psychotrophic drugs for two year olds as way past “the height of insanity” in my book. I have not personally “gotten” precribing psychotrophics for children. We’ll have to get a hild psychiatris on board to discuss this. I’d have to stay out of it.

I would also not “categorize” an “overwhelming sense of oneness” as psychosis. This has been the goal of mystics for as long as there have been mystics.

I don’t just see this as Psychiatrists. Equally though I don’t see the examples given as relevant.

We acknowledge the dangers of driving, and our laws reflect this. Within Australia massive changes have been made to our licencing and learning driver laws to reflect the dangers. We regulate it, and we make safter cars and safer roads and attempt to change driver behaviour.

No one says that tobacco is good for you. Again within Australia our laws are becoming tighter all the time in regard to this. You can no longer smoke within 10 metres of the doorway of any building, under covers in public spaces, you can’t even smoke at bus stops, let alone any other form of public transport. The age of legally being allowed to smoke has increased, advertising has been banned, and the packets are changing, not just for photo’s and health warnings of dangers, but now also to plain packaging, and it must be offensive as the tobacco companies are taking a high court chanllenge on about this one, saying it is illegal for hte government to do. Equally tabacco is being increasingly taxed to make it more expensive, and government funded quit programs are now for everyone and every prodcut that could help.

Much is being done to help with binge drinking, fast food and the like. Our primary (elemtary schools) now often have gardening and cooking classes so children learn to prepare the food they have grown. This is being rolled out with government funding.

Now consider psychaitry. I don’t just blame the doctors. I question how it is we have given one profession so much power over others and how we have not asked questions. But this is not just about the current medications and brain disease paradigm of care. From reading Mad in America it is easy to see that NOTHING has changed in relation to psychiatry. The weapons they use to torture people may have changed, but there viewpoints have not changed. They have the EXACT same arguments today as they had 200 years ago. That blood letting, burning, whipping, drowning therapies and the like were all good for us, and it was our defective brains that made us request not to have them, not that they actually hurt us. They were medical treatments for medical conditions!! And it was our diseases that made us not understand the theraputic nature of the treatments. Nothing has changed in there perception of things.

Equally though it is not just psychiatrists and not just medications. For me personally Cognitive Behavioural Therapy is one of the most abusive treatments I ever experienced. For me I would outlaw it long before I outlawed medication. It is also beyond me as to how psychologists have become so dependent on something that goes against there training. Psychologists do extensive study on child development, something Psychiatrists do not have, but need. BUT in the final years when they start learning treatments – therapies all previous training goes out the window and now they view everyone has having defective thinking if they do not think like them. Now they claim to be able to change the world with thinking classes. They totally forget that thoughts are ALWAYS based on experiences. If you don’t like how someone is thinking you need to change the experiences, not tell them they think wrongly. But they at most believe that if you tell someone that they are thinking wrongly they will be able to create those new experiencs for themselves??!! And of course added to that is the positive thinking brigade and everything will be cured by thinking positively. Perhaps you need to give someone something to think positive about first!! Yep, a homeless person will find themselves a home by thinking positively!!

And of course we now have peer workers, chosen because they are deemed to have been cured enough. They then come in and tell people how to fix themselves, simply by telling them that is you just did what I did you too will be cured like me!! A person who experienced drug induced psychosis tells a person with a profound level of dissociation due to be the most profound child abuse that all they need is the same medication and thinking classes that they had. They tell them that if they just do what they did all will be cured for them as well. Supposedly a person will feel better having someone with a totally unrelated experience and with NO training at all telling them how to follow the doctors instructors. A blind person does not require someone who has been cured of blindness telling them how to live. In fact the whole concept that somone who has been cured of something can tell those going through something slightly similar how to live is beyond all comprehension, but when it comes to mental health, nothing should suprise us.

Yes, there are experience, exsistential and cultural things (to list only three) that play a huge part in pain and suffering. Imagining that we (or our mothers) are “responsible” for all life’s suffering is narrow. I think that exploring these is an important part of cognitive and behavioral therapies. I’ve successfully “prescribed” (in my version of CB therapy) a wide range of life changes including relocating to a sunnier climate. I’ve successfully “precribed” to a young person trapped “in the box” of public education a change to another education venue. I’ve prescribed pets, plants, walking, smiling, food changes,playing, laughing, meditation, tai chi…the list is long and always growing.

While addressing how we run our thoughts and feelings is an important part of CB therapy, the ways to make a life that works better for an individual are as different as there are numbers of people.

It’s also important to know what you can change and what you can’t.

Thanks for the lovely post.
Best,
Alice

PS We are still killing more Americans with cars in the USA every year “accidently” that our intentionally fought wars (by my internet sources of statistics). This is not counting the emmissions poisoning the planet or any deaths from manufacturing, fuel aquisition or auto maintenance. We need more work on safety standards or less driving.

Dr. Keys, this back and forth has me wondering, are there other areas of medicine that involve involuntary treatment? Or where the power of the courts can be brought to bear to coerce treatment? If someone is diagnosed with high blood pressure, obesity, or diabetes are they forced into various treatments?

If not, how is it that we view the “care” prescribed to persons diagnosed with mental illnesses to be so vitally important they should be forced to receive it, regardless of what they want?

Pliny the middle-aged,
Yes there are. I have seen many ICU pateints in restraints, many geriatric medical patients in “posey belts” (restraints) to keep them from falling out of bedor wandering. I have had to “restrain” confused or intoxicated medical patients in ED to perform necessary life-saving care.

I have seen chidren and adults have treatment for acute medical illnesses forced upon them against their will. This depends on the state. Some states will remove a kid from parents’ for withholding care for religious reasons.

Verbal coercion is used every day in the offices of primary care doctors. I have experienced this first hand in protecting myself and my spouse from toxic cholesterol lowering drugs. Even the insurance company and corporate employer got in on the act. They charge an extra $600 a year in premiums for our making the choice of not taking the unproven and toxic drugs.

Coercion, forced medication and restraints are not just a psychiatric issue. No legal committemnt or review document is required for any of this in the medical environment or nursing home.

Thanks for stepping back and broadening the view. This is important.
Alice

anonymous,
I compare the marketing of drugs to the marketing of drugs. Both categories of drugs have serious side-effects and are used for things never approved. I review the programmable cognitive filters we all have and how drug marketing works with this.

I am certain our (you and I) programmed cognitive filters do not match perfectly. It would be unlikely that any two humans would ever be identical.

I don’t believe I’ve written yet to address “force” and “involutary psychiatry”. I believe others write widely about these issues here.

Hello. I’m not a psychiatrist, but I’ve suspected for the past ten years, while navigating through the mental healthcare system in my attempts to help my son, that the use of antipsychotics is toxic and dangerous.

More than a suspicion, all along I’ve had a gut feeling, one which I was told to ignore by psychiatric professionals, that there is a better way to approach treatment than using antipsychotics.

I am reminded, for some reason, of remarks I’ve heard from psychiatric professionals.

“You must abandon everything you’ve ever believed or felt about what it means to be a Mother,” a well-respected and experienced social worker once said to me, regarding how a parent goes about convincing a son or daughter that antipsychotics must be used, whether he or she wants it or not, aka forced treatment.

“You have to abandon your Motherly instincts if you want to help your son.” (quote by a treatment team’s psychiatrist) I once asked that particular psychiatrist what she thought about alternative methods of treatment. She said she wouldn’t waste her time reading about any and also thought it, “absolutely absurd,” that there are people who, “go as far as to call themselves survivors.”

I wondered how she could practice psychiatry, without at least considering the other avenues of treatment, as well as what seemed to me, her complete dismissal of any research indicating that antipsychotics are dangerous.

Fortunately, my son was blessed with a lone psychiatrist during the crisis that prompted the remarks I quoted. The doctor saw him as a full human being, perhaps lost in this world, but who needed a kind environment. He told me, that based on his knowledge, as well as having spent time talking and getting to know my son, that he could very well live a much healthier and longer life without antipsychotics.

I was grateful that doctor was the one they had assigned to my son. The outpatient psychiatrist who said she would never take time to research treatment outside of using antipsychotics, was outraged. She said it only enforced my son’s belief that he could live without antipsychotics, which he can.

This happened several years ago, so I guess, honestly, I just don’t get it why so many psychiatrists haven’t been suspicious and/or investigating things when it comes to the negative effects and adverse events in the use of antipsychotics.

How could you have known? I would think by reading, researching and keeping up with the latest news and cutting edge research, but that’s just one person’s view.

I hope I have not strayed too far, nor crossed the lines of a civil dialogue. I really appreciate your article and views.

As to the metaphors used in this post, I have to agree with a few others here, which is that in psychiatry, choices in treatment are rare. I think that’s the main difference. Personally, I can’t wrap my mind around how psychiatric treatment is like driving and smoking cigarettes.

I think many psychiatrists (and others) refuse to consider evidence contrary to what they have been taught because, to do so might reveal to them the harm they may have caused many people, and unleash feelings of guilt and betrayal to those they had trusted. It unveils what appears to be a “massive paranoid conspiracy theory” within their educational and professional lives (which is what a lot of people think that Big Pharma indeed is).

It’s easier for many people to maintain the tension of cognitive dissonance and refuse to consider alternate explanations for the things happening right in front of them, than to allow themselves to see a different truth and risk falling into their own painful emotional abyss.

I have a friend who is going through a stressful time who took antidepressants for awhile, not forced to, but bought into the thinking. He is in withdrawal and keeps looking for an “alternative” by which he means a “natural” cure.

Preferably something that comes in pill form.

So here we go again, with wanting a pill solution for problems that are human, situational, and spiritual.

Millions of dollars are made by sales of supplements and so called alternative and natural cures. These are just as bad as big drug companies, no more regulated, and many times just as or more harmful.

These companies/institutions/ groups whatever should not be let off the hook, either. (Think of the weight-loss industry and all the death and destruction from medical and non-medical treatments gone wrong.)

I just finished reading “Overtreated” by Shannon Brownlee. It was written before the healthcare debates of 2009, so it’s somewhat outdated. I would recommend it for anyone who wants to see that this problem is not just in psychiatry.
Another book is “Overdosed” by John Abramson, along the same lines.

Marianne,
You are exactly on topic. Our pill culture is big. Psychiatric pills are a part of a much bigger problem.

If all psychiatrists vanished today (Okay. No applause ;-)) the problem of overprescribing on all fronts would go one unchecked. People still would be clamoring for pills (supplements are in this category to me). All the other “prescribers” would go on filling the artificially created “need” for pills.

Aside from the huge dilemmas of modern society (which in my opinion are a digression), I’m still wondering how a psychiatrist can miss listed adverse effects of a prescribed drug in the patient right in front of him or her.

Alice, many of us are seeing this argument as an evasion of the issue. Carbon emissions are a straw man.

All of us are in “the system.” Even doctors who are thoroughly indoctrinated in nonsensical “chemical imbalance” etc. theories are capable of recognizing side effects from medication. One does not preclude the other.

So if you’ve missed recognizing an adverse effect, what was your thought process at the time?

Altostrata,
People driving deadly cars every day is an illustration of the programmable cognitive filter all of us wear. It allows all of us to miss important information. Sorry you missed the point. You are not the only one. I will work toward more clarity in future posts. I’m new at this.
All the best,
Alice

Altostrata,
You would have to give me the specific patient and the specific missed side effect that I, specifically missed for me to answer your question about MY thoughts at that time. It is not possible for me to answer such a general “if” question. Perhaps you could take a swing at it yourself?

What utter nonsense! This article starts with a comparison that’s not valid. Driving a car is something that a person generally does because our society makes it necessary or convenient for survival or a decent life. Tobacco and fast foods are things people use for their own personal reasons or convenience.

Psychoactive drugs are things that psychiatrists give to others, not things they use themselves. Psychiatrists are the gatekeepers to these things, or at least, should think of themselves as such. Instead, they push them on others.

It is the psychiatrist’s job to know what these things do. It’s the psychiatrist’s job to know what harms they produce. It’s the psychiatrist’s job to find out how they affect the patients.

This is not an issue that can be absolved by trying to compare the pushing and forcing of drugs onto other people with the personal choices people make to use harmful things. That’s specious and self-serving.

A cute head bucket analogy doesn’t prove anything beyond an ability to portray an issue in the wrong framing. Surely a psychiatrist knows that you can prove nothing through analogies. They’re good for explaining a concept, but they do not document its validity.

As answer to the author’s final question, How could she have known? The answer is simple. She could have known by looking. Others have done so. Had she written the article as an apology, it might have been acceptable. Instead, she wrote a piece that said, “Golly gee, it’s not my fault that I’ve done horrible things. I was just doing what all the other shrinks do and profit from. How could I have known? Just look at my clever excuse.”

This article is not only about the “head buckets” (programmable cognitive filtering systems) of psychiatrists. Our deadly habits of driving cars is meant to be an example of how any human, including psychiatrists, could “not know” something even IF the information is right in front of them. It is meant to be an illustration, in the ordinary human words that work best for me, of how all of us are vulnerable to this built-in operating system.

Sorry the metahor didn’t work for you. Back to the drawing board… I mean lap top.

Thank you for responding. I realize that your metaphor is meant to cover greater territory than psychiatrists’ penchant for prescribing drugs. That’s the problem with it. It strikes me as obscuring rather than explaining. The situations of the metaphorical examples are quite different and the obligations of people are different.

The problem isn’t that the metaphor didn’t work for me. It’s that the metaphor is not appropriate and misleading. Psychiatrists have a duty to investigate the treatments they press on patients. To compare that obligation with smoking tobacco obscures the psychiatrist’s obligation to the patient.

To hide behind the idea that people do things without thinking simply isn’t an excuse when the person involved is a gatekeeper who can place the lives of others at risk. Please don’t try to suggest that you – or any other psychiatrist – is unaware of the dangers of these drugs.

It would have been ever so much better to have heard an apology for the harm done, rather than an excuse for it.

Indeed, Heidi! The relationship between doctor and patient is asymmetric with the obligation flowing from doctor to patient, not the other way around. If doctors find the distress of patients who now live with iatrogenic illness because of medication they prescribed unpalatable and/or uncomfortable they still got the better end of the bargain. Perhaps they can use the fees that we pay to purchase themselves some soothing massage. Meanwhile, we’re still in recovery.

I’ve recovered from the event induced depression, not the effects of withdrawing from an SSRI which I manage daily as I taper off of the medication. As I said in a previous post, I have more than another year ahead of me before I can clear this drug from my system and with hope completely restore my brain and body to their healthy pre-drug state. A faster taper (which I have tried) will render me too sick function. I’m grateful that I didn’t buy the explanation that I was simply reverting to my pre-drug state rather than experiencing withdrawal. How can one revert to a state that they’ve not experienced prior?

Heidi,
I get these posts in order of time stamps so the threads are jumbled for me. Apologies if I repeat myself. You are not the only person who misunderstood my point. I shall truely have to work more at clarity in my writing. I suppose there will always be some I cannot reach. It is as it is.

All of us, every single struggling, searching, thinking, researching human has a programmable cognitive filter in place. Me. You. All of us.

Having very real “obligations” to patients does not change the limitations of this operating system every human organism has. Me. You. All of us.

I, also, wish I had been bequeathed with special and different powers, for example: to see the future, see what’s hidden, to be immune from marketing.

Some people THINK they are different and immune. This frightens me.

Others imagine I am. This frighens me as well.

This is the point of my “bucket metaphor” stripped of the bucket. This is as clear as I can be.

I hear your wish for an apology. If I have done something to harm you personally, here with my words, be sure it was not intended. For that I am willing to say I’m sorry.

Is bringing up car accidents, smoking and junk food really helping to explain why a person gets involved with prescribing psychiatric drugs? Psychiatric drugs I think actually help cause car accidents (they deaden reflexes), they don’t really help a person make good choices (junk food) and people on neuroleptics often smoke because it helps to counteract the suppression of dopamine, I understand.
I believe that a more valid comparison would be: “how do people ever fall into prejudice?” No one wants to be discriminated against but it happens everywhere. The most decent person I perhaps ever talked to, the most civilized, was a homeless person I bought a pint of strawberries for. Everywhere one is told to be respectful, but this man truly was. And yet he would be seen as a worthless part of society, because he doesn’t have a job. Seeing these people as having chemical imbalances is just another way of negating prejudice against them, even if you think that this would help them to become functional. It’s not them. They have a valid story, even though happiness is associated with having a job and a home; and they don’t. Listening to their story will help society, “medicating” them won’t.

Nijinsky,
These are not meant to be direct correlates of psychiatry but rather examples to demonstrate my idea of a programmable cognitive filter on all of us. You are not the only one to miss this so I shall have to get better at tossing them.
Best,
Alice

Excellent. As an instructor, if I don’t know the answer to something, I will be honest and look it up! I found that in my experience with prescribers, they do not admit they are wrong. I have been blamed by prescibers for their mistakes (What do you mean you’re only taking 100mg of that!?— My reply– that’s what you told me- you asked me to reduce my dose). Physicians also seem to get defensive when I tell them my educational background in experimental psychology (I don’t deal with clinical psych– but am well trained in research methods).

I expect that physicians and other prescribers be held to a higher standard than the automobile industry or fast food restaurants. The comparisons you provide are moot.

In addition, clinicians (whether psych or other) are typically not well trained in research methodology. This is not the fault of individual MDs or others because clinical work does not focus on lab or research work. I go into physicians offices and I ask the tough questions. I have been trained in research methodology and I ask for data– any sort– aside from “personal experience”. Not that this experience is not valid– it’s just far from the objectivity typically found in research. Yes, there are many drug trials that are funded by drug companies– but usually, these studies are easy to point out and should be taken with a grain of salt. There are Universities out there that can afford drug research– those are the publications to focus on. This site is a great way to get in touch with better research.

I’m tired of people falling for research that is poorly done– it’s akin to saying that store brand shampoo is any better or worse than a similar shampoo–based on “studies”.

Maybe prescribers should get over this “how could I know?” mentality and focus on changing and learning as much as possible– and getting the word out to fellow prescribers. Yes, this will take time– but it could also save lives or at least improve people’s lives.

Dr. Keys – Thank you for writing this article which starts a much needed conversation. So many have replied eloquently and covered this topic in depth.

I just want to emphasize that you please do NOT trivialize the severe damage and the trauma that coercive psychiatry, forced drugging and ECT have on human beings.
Minds and bodies and lives are ruined, sometimes forever by these practices, while psychiatrists merely suffer from having a ‘bucket on their head’.